Abstract
Distal ruptured fusiform middle cerebral artery (MCA) M4 segment aneurysms are rare and their management is a challenge to the neurosurgeon. Fusiform aneurysm of M4 part of is even rarer. Patient usually presents with headache or neurological deficit. Computed tomographic angiography helps to confirm diagnosis. Treatment involves micro-neurosurgical clipping or trapping and excision of aneurysm. Early surgical intervention of distal middle cerebral artery aneurysms favours better outcome. We report a case of 20 year old female patient who presented with complaint of severe headache. Neuroimaging was suggestive of right M4 middle cerebral artery fusiform aneurysm with intracerebral haemorrhage. Patient was managed by trapping and excision of aneurysm and recovered well.