Presentation
Dizziness and recurrent fainting attacks.
Patient Data
Mild atherosclerotic changes.
Moderate stenosis at the bifurcation of the left common carotid artery and marked stenosis of the proximal left internal carotid artery just distal to its ostium.
Attenuated calibre of the cavernous segment of the right internal carotid artery.
Moderate narrowing of the cavernous portion of the right internal carotid artery (C5 segment).
Both vertebral arteries show hypoplastic V5 segments. Both PICA are seen emanating from the hypoplastic V5 segments.
Markedly hypoplastic lower part of basilar artery.
Persistent left trigeminal artery is seen originating from the posterior aspect of the C6 segment of the left ICA showing turtuousity within the sellar cavity and emerging through the posterior sellar wall to reform the calibre of the superior segment of the basilar artery. The persistent trigeminal artery showed mid-segmental stenosis up to 80% area stenosis at the level of crossing of the posterior sellar bony wall.
Case Discussion
Persistent primitive trigeminal artery is a rare variant of the posterior circulation. It is one of the persistent carotid-vertebrobasilar anastomoses. Here it is considered Saltzman type I as it supplies the distal basilar artery and is associated with hypoplastic caudal basilar and distal vertebral arteries.
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