Intracranial aneurysms are uncommon in children. Rupture of giant intracranial aneurysms is extremely uncommon in infants even in autopsy studies. In this report, we present an unusual case of ruptured giant middle cerebral artery aneurysm in an 11-month-old female infant who presented acutely with unresponsiveness and seizures. The aneurysm was clipped during an urgent craniotomy for evacuation of an associated hematoma. She recovered slowly with mild residual right-sided weakness. Follow up arterial angiography revealed no residual or other aneurysms. Further follow up revealed motor delay and recurrent partial seizures. Active physiotherapy was performed and she could walk independently by 3 years of age. We conclude that intracranial aneurysms have to be considered in the differential diagnosis of infants presenting with acute raised intracranial pressure. Favorable outcome is noted in children who are managed promptly in hospitals with neurosurgical units.