Presentation
Intermittent diplopia, abducting nystagmus. Probable internuclear ophthalmoplegia.
Patient Data
Normal MR of the brain with no lesions.
Axial MRA shows persistent primitive right trigeminal artery coursing through the right side of the prepontine cistern and abutting the right ventral aspect of the pons close to the exit site of the right abducens nerve.
Case Discussion
Persistent primitive trigeminal artery is usually an incidental finding with no clinical significance, however, it has been reported to be the cause of abducens nerve palsy with paresis of the lateral rectus muscle and subsequent diplopia 1.
In this case, with a workup of diplopia, all investigations were normal except this MR finding which was well correlated with the clinical examination and presumed to be the culprit lesion of the patient's complaint.
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