Giant aneurysms of the cavernous carotid artery are rare entities which present predominantly with features of compression of the adjacent neural structures, most commonly the III, IV, VI and V cranial nerves. Historically, treatment options included occlusion of the feeding vessel, direct surgery on the aneurysm, bypass procedures and in recent times, the use of endovascular devices. While intramural thrombus formation is commonly seen in giant aneurysms, we present 2 cases of giant cavernous aneurysms which on evaluation were found to have spontaneous occlusion of the feeding internal carotid artery secondary to thrombus formation, and review the available literature regarding the same.

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Figure 1: The sinus cycle length showed progressive prolongation in four beats immediately preceding a prolonged sinus pause of 13 seconds. Similarly, the recovery of sinus activity was also associated with a transient phase of sinus bradycardia as evident in the saturation probe tracings. In addition, the event review panel (lower half of the figure) shows the occurrence of another episode of extreme sinus bradycardia (as defined rate less than 30 bpm as per the monitor settings) an hour prior to the index eventbe life threatening leading on to unexplained death and may require temporary pacing. [1] This also highlights the importance of need of continuous ECG monitoring of acute stroke patients in stroke unit.

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