Ruptured giant aneurysm of an occluded middle cerebral artery in a severe-grade patient: case report.

A 27-year-old woman presented with a ruptured giant aneurysm of the right middle cerebral artery, occlusion of the artery distal to the aneurysm, and an intraparenchymal hematoma. Before emergent surgery, her condition deteriorated to a Glasgow Coma Scale score of 4 and a Hunt and Hess grade of V. Electroencephalographic response on the right, initially absent, was present toward the end of the surgery. Postoperative angiography demonstrated good filling of the previously occluded distal middle cerebral artery. The simultaneous occurrence of hemorrhage from a giant intracranial aneurysm and occlusion of the parent artery is extremely rare, and this is the first case we found in the literature in which the patient survived. The treatment strategy and outcome are discussed.