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A 56-year-old woman with hypertension underwent an evaluation for recurrent syncope. On physical examination, the blood pressure and heart rate were normal, with no observed bradycardia or pauses on telemetry, and the respiratory rate and oxygen saturation were normal. The funduscopic examination was normal, with no signs of papilledema. Computed tomographic (CT) angiography of the head showed a partially thrombosed giant paraclinoid aneurysm of the left internal carotid artery, measuring 5 cm in diameter (Panels A and B, arrows). Six years earlier, an aneurysm of the left internal carotid artery (2.2 cm by 1.3 cm) had been diagnosed, but the . . .