Although SAH is the most feared and common clinical presentation of a berry aneurysm, there are other settings wherein an aneurysm may come to medical attention. An asymptomatic lesion may be detected by brain or vascular imaging performed for another indication, for example, for assessment of chronic headaches. Rarely, a giant aneurysm may be a source of thrombi that migrate to a distal intracranial artery and cause an ischemic stroke or transient ischemic attack. Occasionally giant aneurysms may cause compression of adjacent neurologic structures; the most common clinical setting is compression of the oculomotor (III) nerve by an aneurysm located at the bifurcation of the basilar artery or the posterior communicating artery (see Plate 9-40). A giant intracavernous aneurysm may cause multiple cranial nerve palsies, causing an ipsilateral ophthalmoplegia and facial sensory loss.

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