THE CASE OF a patient with a bacterial intracranial aneurysm treated with antibiotics and endovascular obliteration is reported. The patient presented with dysphasia and right hemiparesis. A medical workup revealed endocarditis and associated heart valve dysfunction with no evidence of congestive heart failure. Computed tomography demonstrated subarachnoid hemorrhage, and a subsequent cerebral arteriogram showed a distal left middle cerebral aneurysm, which, as demonstrated by angiography, did not change in size in 2 weeks. An endovascular approach was used to obliterate the aneurysm and its parent vessel. Endovascular techniques may be used to obliterate certain bacterial intracranial aneurysms, particularly in patients who harbor distal aneurysms. © by the Congress of Neurological Surgeons.