Objective: To present a new semiological description of unruptured middle cerebral artery (MCA) aneurysms.
Methods: We present a series of three MCA aneurysms presenting with progressive or paroxystic somatosensory symptoms in combination with visceral, motor, language or autonomic symptoms.
Results: A surgical approach was proposed for two aneurysms, and both patients experienced complete resolution of their symptoms. The third aneurysm was successfully excluded by endovascular coiling but the symptoms persisted.
Conclusions: To our knowledge this is the first description of unruptured aneurysms presenting with insular-related symptoms.