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A 70-year-old asymptomatic man presented with moyamoya disease (MMD)–associated basilar tip aneurysm (BTA) noted on digital subtraction angiography (figure 1, A–D). 4D-flow MRI revealed a concentrated inflow jet with high velocity compared with previous studies1 (video 1 and figure 2, A–F). Considering the high risk of endovascular treatment, the patient chose conservative treatment. After 1 month, the aneurysm ruptured (figure 1, E–F).

Teaching Video NeuroImages: High blood flow velocity in the parent artery prior to basilar tip aneurysm rupture