Thrombosed cerebral aneurysms can cause embolism of the distal cerebral arteries and manifest as the development of ischemic stroke or transient ischemic attack. As a rule, thromboembolic complications develop with giant and large aneurysms, but they are also possible with sizes less than 1 cm. In case of such complications, according to the standards of treatment of ischemic stroke, antithrombotic therapy is necessary, which is associated with the risk of rupture of the aneurysm. The article presents our own clinical observation of the development of ischemic stroke against the background of an embolism from the sac of a thrombosed aneurysm of the internal carotid artery in a young patient, which was later complicated by aneurysm rupture and subarachnoid hemorrhage, which required urgent surgical intervention.