Persistent trigeminal artery as a rare cause of vertebrobasilar insufficiency

Abstract

The persistent trigeminal artery (PTA) is the most common fetal carotid-basilar anastomosis which may persist into adult life. In the literature there are numerous papers referring to the anatomical characteristics of this anomalous vessel. In the majority of cases PTA is an incidental finding and its clinical significance has been debated. Some authors describe the coincidence of PTA with various clinical syndromes. However, there are few reports linking PTA with the symptoms of vertebrobasilar insufficiency. We present a patient with a 3-year history of recurrent dizziness and impaired vision, precipitated by physical activity, in whom neuroimaging techniques revealed a persistent left trigeminal artery (PTA). In our case the occurrence of PTA might have been related to the clinical manifestation and the potential mechanism will be discussed.

Persistent trigeminal artery incidentally found in a patient with brain posterior system infarction: a rare case report

“…PTA is mostly asymptomatic. However, in the literature, pathological conditions, such as aneurysms, vascularnerve compression, trigeminal cavernous fistulas, and thromboembolic ischemia, as well as associated neurological conditions, palsies of the third sixth cranial nerves, trigeminal neuralgia, vertigo, ataxia, migraine, and headache have been described in patients with this variation (2,4). In this report, we present a case of PTA variation with multiple foci of infarction in the posterior arterial system irrigation area and no arterial occlusion.…”

“…PTA is the most common variation of the four wellknown embryological primitive anastomoses between the carotid and vertebrobasilar systems and can be accompanied by vascular pathologies, such as stenosis, occlusion, and dissection and vascular variations, such as the congenital absence of ICA (2,5,6). In addition, this variation may be a cause of vertebrobasilar insufficiency (2).…”

“…PTA is the most common variation of the four wellknown embryological primitive anastomoses between the carotid and vertebrobasilar systems and can be accompanied by vascular pathologies, such as stenosis, occlusion, and dissection and vascular variations, such as the congenital absence of ICA (2,5,6). In addition, this variation may be a cause of vertebrobasilar insufficiency (2). Considering the conditions accompanying this variation and associated pathologies, there may also be a relationship between the presence of PTA and the formation and volume of infarction (5).…”

“…PTA accounts for approximately 85% of all persistent presegmental arteries (2). In digital subtraction angiography (DSA), PTA is observed at a rate ranging from 1 in a 1,000 to 6 in 1,000, and it is usually unilateral (2,3). In radiological examinations, almost all cases are detected incidentally.…”

Due attention should be paid to persistent trigeminal artery in trigeminal neuralgia

“…K. Sulima reported a case of VBA insu ciency caused by PTA. 17 Also, Daiki Watanabe found that the PTA was associated with ipsilateral hypoplasia of ICA. 21 PTA related carotid cavernous stula, 9 aneurysm, 4,20 and arteriovenous malformation 9 were also reported.…”