The visual pathways and the ocular motor cranial nerves are frequently injured by expanding cerebral aneurysms. Neuro-ophthalmologic signs and symptoms may be the only indications of an aneurysm prior to rupture. Acute or chronic visual loss may herald an aneurysm prior to rupture. Acute or chronic visual loss may herald an aneurysm in the carotidophthalmic, supra clinoid carotid, internal carotid bifurcation, or anterior communicating artery distributions. Diplopia and retro-orbital pain may be warning signs that precede the discovery of a posterior communicating, basilar, or cavernous sinus aneurysm.