Unruptured intracranial aneurysm and first episode psychosis: The mystery was finally solved.

Incidental findings on Head MRI and CT scans are common in the general population as well as in patients presenting with first episode of psychosis (FEP). Though unruptured intracranial aneurysms (UICAs) are among the incidental findings, they are rare in those under the age of 30. We present a case of a young man (28) who presented with FEP and unruptured intracranial aneurysm. The implications to treating physicians are discussed given the rareness of the two to be found together in the given age group. Following physical examination and several physical tests including both CT and MRI scans, it was established that in addition to psychosis, the young man had an unruptured intracranial aneurysm on the right anterior communication artery. The psychosis continued despite successful treatment of the aneurysm. It was concluded that the aneurysm was an incidental finding. UICs under the age of 30 in patients presenting with FEP are more likely to be coincidental findings rather than the underlying cause of psychosis. However, clinicians need to remain vigilant by conducting physical examination including neurological examination for patients presenting with FEP. The need for brain CT or MRI scan should be informed by clinical presentation and the findings on physical examination.