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

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.