One month after clipping of an unruptured basilar tip aneurysm, this 43-year-old woman, recently divorced, experienced difficulty producing speech. She also had recent hospitalizations because of unexplained abdominal pain, chest pains, and syncope.

Six weeks following clipping of an asymptomatic, unruptured, basilar tip aneurysm, our patient had changes with her speech. At first, she was unable to speak at all. She improved, although fluency remained impaired, with frequent stuttering. She also had difficulty remembering “sequential things,” by which she meant she had to read instructions a number of times, such as those for getting to our clinic. She also could not remember recipes. She denied any sense of sadness or dysphoria and did not seem particularly disturbed or upset by the idea that her speech problem might become chronic and prevent her from returning to work. Postoperative magnetic resonance imaging (MRI) of the brain and catheter cerebral angiogram showed the basilar tip aneurysm clip, but they were otherwise unremarkable. Ears, nose, and throat (ENT) evaluation showed inconsistent glottal closure with laryngeal tremors.

There were some marked social stressors in our patient’s recent past. Her husband reportedly left her abruptly after 24 years for another woman whom she did not know. She denied other prior stressors including financial pressures or health problems in her family or children. She had no previous problems at work with her colleagues. She reportedly liked her work, and denied any symptoms of obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, schizophrenic disorder, bipolar disorder, or posttraumatic stress disorder.