A case of cavernous-internal carotid artery aneurysm with delayed rupture into the sphenoid sinus is presented, and the literature reviewed. We stress important diagnostic features such as epistaxis, which may require emergent use of epistaxis balloon catheters. Cervical carotid ligation and intracranial clipping of the internal carotid artery proximal to the ophthalmic artery controlled the bleeding and resulted in no neurologic sequelae.