Presentation
Presenting with severe right sided headache and blurred vision. Hypertensive on arrival
Patient Data
The left carotid branch arising from the aortic arch is relatively small in caliber, measuring 5 mm in diameter. At the level of bifurcation, the left internal carotid artery is not seen, suggestive of congenital absence, which is supported by an absent carotid canal. Other differentials include chronic thrombosis. Collateralisation from the left PCOM supplies the MCA territory and its branches.
Incidental finding is noted of an intracranial aneurysm at the bifurcation of the left MCA, measuring 4 mm in size.
The vessels of the Circle of Willis are all patent and well opacified.
Case Discussion
Incidental finding of congenital ICA absence.
The collateral circulation provided by the other arteries of the Circle of Willis compensates for the absent ICA.
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