SUMMARY A 34-year-old man had a transient ischemlc attack and subsequently a completed stroke. Arteriograpby revealed a large fusiform aneurysm of tbe left middle cerebral artery with intralumlnal thrombus. At surgery, the thrombus was seen within the lumen of the aneurysm. Absolute evidence for embolization is lacking as no examination for this could be done.Embolization from intracranial aneurysms seems to occur exclusively in large or giant aneurysms. Turbulent flow and a "stagnant zone" probably promotes thrombus formation. Tbe reasons for tbe relative rarity of subsequent embolization are discussed.Because embolization from intracranial aneurysm is so uncommon and because aneurysms usually produce focal deficit by other mechanisms, 4 criteria are presented to determine whether embolization is likely. Stroke, Vol 11, No 2, 1980CEREBRAL ANEURYSMS generally produce neurologic deficit by means of hemorrhage, vasospasm or mass effect. Embolization from cerebral aneurysms is rarely mentioned in reviews of transient ischemic attacks (TIA), non-atherosclerotic causes of stroke, and the non-hemorrhagic consequences of cerebral aneurysm. "'Case Report A 34-year-old, white, right-handed man was admitted with aphasia and a right hemiparesis. He had been in good health until 10 days previously, when he experienced lightheadedness and right hemiparesis lasting 5 minutes. Six days later, he had a similar attack from which he did not fully recover. There were no associated headache or other neurological symptoms. There was no history of diabetes, hypertension, or other significant medical diseases. Family history was also unremarkable.Examination revealed an alert, cooperative man with a moderate Broca's aphasia. There was a mild, right central facial paresis and a right hemiparesis affecting the arm more than the leg. He had rightsided hyperreflexia with bilateral flexor plantar
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