An incidental saccular intracranial (berry) aneurysm is not an uncommon finding at autopsy. Rupture of such an aneurysm can produce severe neurologic deterioration and death, often without warning. Morbidity and mortality can be reduced in some patients with early surgical intervention. Familial aggregation of cerebral aneurysms occurs frequently enough to warrant screening of family members to diagnose an asymptomatic berry aneurysm. We review the etiology, clinicopathologic features, and natural history of berry aneurysms and aneurysm rupture, as well as the various screening methods. A careful examination of the cerebral vessels should be routine in every postmortem examination, regardless of the cause of death.