Intracranial mycotic aneurysms (IMA) occur in 1-3% of all infective endocarditis. Although spontaneous resolution was evidenced on serial angiograms in many asymptomatic cases, the prognosis, if they rupture, is reported to be worse and partly contingent on the therapeutic approach. Among 12 patients (six acute and six subacute endocarditis) with ruptured IMA, six were treated surgically and four were treated medically. Two patients died during rupture before any treatment could be started. Six patients had a sudden rupture manifested by coma, less clear consciousness seizures, hemiparesis unilateral mydriasis. CT-Scan showed intracerebral, intraventricular and subarachnoid haemorrhage. Ten angiograms showed 11 IMA. For patients with ruptured IMA, the decision for surgical treatment was made in the presence of deepening coma and extensive mass-lesion on CT-scan (one of six died in the postoperative period). Others received medical treatment (four cases: all survived) and were followed-up with serial angiographies. Of the nine patients who survived, five remained free of any disability 1-4 years later. We suggest that the prognosis of ruptured IMA (25% mortality rate) is not as bad as previously reported if surgery following angiography is performed early in the presence of deepening coma and extensive lesion.