# Thrombosed Middle Cerebral Artery Bifurcation Aneurysm Presenting as Acute Ischemic Stroke

## TL;DR

A rare case of a brain aneurysm causing stroke is presented, highlighting the need to consider aneurysm thrombosis in stroke diagnosis and the potential for surgical treatment.

## Contribution

This case report adds to the understanding of ischemic stroke caused by thrombosed aneurysms and suggests surgical resection as a viable treatment.

## Key findings

- A thrombosed aneurysm at the middle cerebral artery bifurcation caused acute ischemic stroke in a 69-year-old woman.
- Surgical resection and clipping of the aneurysm was performed successfully.
- The case emphasizes the importance of considering aneurysmal thrombosis in stroke differential diagnosis.

## Abstract

Ischemic stroke caused by a thrombosed intracranial aneurysm is a rare clinical condition that presents distinct treatment challenges. We report the case of a 69-year-old woman with vascular comorbidities who was found unresponsive and presented with acute left-sided hemiplegia, aphasia, and rightward gaze deviation. Imaging revealed a large, unruptured, thrombosed aneurysm at the right middle cerebral artery bifurcation, with occlusion of the parent M1 segment. The patient underwent a right pterional craniotomy for resection of the thrombosed aneurysm and surgical clipping of three additional intracranial aneurysms. This case underscores the importance of including aneurysmal thrombosis in the differential diagnosis of ischemic stroke. Although management is complex, surgical resection and clipping of thrombosed aneurysms may offer a viable treatment approach.