36 year old woman presented to the hospital with severe headaches and was also found to have heart murmur due to bacterial endocarditis, an infection of the valves within the heart that requires treatment with antibiotics.  MRI brain scan showed evidence of a previous subarachnoid hemorrhage, a form of stroke.  Cerebral arteriography (top images) revealed diffuse narrowing of the brain blood vessels compatible with reactive vasospasm following prior subarachnoid hemorrhage and a small mycotic (infectious-type) aneurysm of a middle cerebral artery branch (top images, black arrows).  The patient underwent endovascular treatment of the aneurysm and diffuse vasospasm (lower images).  The aneurysm was occluded with platinum coils (GDC: Guglielmi Detachable Coils, Boston Scientific Co., Inc., Fremont, CA).  The vasospasm was then treated using balloon angioplasty and a vasodilator medication to improve cerebral blood flow in order to help prevent stroke that often results from recent subarachnoid hemorrhage.