Persistent trigeminal artery
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Bilateral narrow vertebral arteries lumens with minimal flow void on T2 images and absent flow on MRA.
Trident sign reflecting persistant trigeminal artery passing through superior aspect of the left Meckel's cave and joining to hypoplastic basilar artery, supplying posterior circulation (nice seen on the coronal images).
Central disc extrusion at C5-C6 segment.
2 case question available
Incidental finding on the neck MRI in patient with vertigo and vertebral artery syndrome, only the single persistent trigeminal artery supports posterior cerebral blood circulation.