Introduction: Intracraneal aneurysms are frequent in medical practice, most of them never produce symptoms, that is why occasionally, they are not diagnosed before death. Sacular is the most frequent aneurysm, and atherosclerotic aneurysm is rare.
Case report: In this article we present the case of a 75 year old woman who has been suffering from high blood pressure and coronary artery disease since more than 20 years and in the last four months she had been complaining of dysphagia and dysartria. She was taken to the hospital because 24 hours ago mild headache started accompanied by vertigo, nausea and vomiting. On neurological exam we found sleepiness, dysartria, and right braguio crural hemiparesis, therefore we decided admitt her, but after 48 hours left braquio crural hemiparesis was added and later respiratory sepsis appeared. The patient died due to an acute respiratory failure.
Conclusion: Necropsy revealed a huge atherosclerotic intracraneal aneurysm (31 mm) located on basilar artery. The case has been discussed and images were shown.