Purpose: To report four cases of intra cranial aneurysm with different neuro- ophthalmic presentations Method: Descriptive case series Introduction: Intracranial aneurysm is a cerebrovascular disorder where weakness in the wall of a cerebral artery or vein causes localized dilatation of the blood vessel. They are mostly asymptomatic and are present in approximately 5% of the population. Neuro ophthalmic manifestations can be the first presentation in many patients. Usually these presentations depend upon the size, location and the way of expansion of aneurysm. Case summary: 4 patients of various age group of either sex came with different neuro-ophthalmic presentations. After detailed history, clinical examination, routine serological investigations, neuro imaging was done in every patient. Among them 1 patient had left total third nerve palsy and MRA of brain suggestive of aneurysm of left internal carotid artery, 1 had right 6th nerve palsy and MRA of brain suggestive of aneurysm in cavernous part of right internal carotid artery, 1 had left optic atrophy and MRI of brain suggestive of thrombosed aneurysm in sellar and supra sellar region and 1 patient presented with right recurrent optic neuritis, MRI of brain suggestive of giant aneurysm in right internal carotid artery. All the patients were sent to neuro surgeon for definite management and advised to follow up after treatment. Conclusion: Many cases of cerebral aneurysm may present with neuro-ophthalmic manifestations. During clinical examination it should be kept in mind so that these life threatening conditions may not be over looked.