Case Report: Medical management of a rare infectious basilar artery aneurysm.

Introduction: Ruptured infectious basilar artery aneurysms, which are complicated by hemorrhage, typically necessitate interventional therapy and are associated with an unfavorable prognosis. In contrast, successful outcomes following the administration of conservative medical therapy for unruptured infectious basilar artery aneurysms have rarely been reported. Clinical presentation: A 30-year-old male presented with acute confusion and dysarthria, which led to a diagnosis of cerebral infarction. Evaluation revealed a ventricular septal defect with secondary infective endocarditis (IE), which caused inflammatory embolization. After aggressive anti-infective therapy, his symptoms resolved. Subsequent vascular imaging demonstrated multiple basilar artery aneurysms. The family declined both interventional and cardiac surgical treatments, and the patient was maintained on antiplatelet therapy. Eight-month follow-up imaging revealed complete aneurysm resolution without rupture. Conclusion: Despite the rarity of infectious aneurysms, cerebrovascular imaging is recommended for patients with systemic infection and neurological symptoms. This case confirms that management strategies must be individualized, as unruptured infectious aneurysms can achieve complete resolution with pharmacological therapy.