A 59-year-old female with a previous history of head injury presented with mild occipitalgia due to dolichoectasia of the middle cerebral artery (MCA). Initial examination by computed tomography and angiography using the usual projections suggested a terminal internal carotid artery saccular aneurysm. However, angiography by the reverse Waters view excluded a saccular aneurysm. Superselective angiography using a microcatheter revealed the complex tortuous course of the MCA due to dolichoectasia. She was discharged and has remained asymptomatic. Superselective angiography is extremely useful for the diagnosis of dolichoectasia localized in the MCA.