An unusual case of nondysplastic saccular aneurysm associated with elo
ngation of the extracranial internal carotid artery is reported. The a
rtery was normal except for a punch-hole defect in the media, which di
stinguished it from true fibromuscular dysplasia. Although neurologic
symptoms and treatment were not specific, this case is interesting in
that the exact cause of the aneurysm remains unknown.