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[Persistent primitive proatlantal intersegmental artery (PPPIA) presenting with cerebral infarction]

M Ishiguro1, T Sohma, H Tsuchita

  • 1Department of Neurosurgery, Sapporo City General Hospital.

No Shinkei Geka. Neurological Surgery
|June 1, 1991
PubMed

Insights

A rare persistent primitive proatlantal intersegmental artery (PPPIA) was identified as the cause of a patient's stroke. This vascular anomaly rerouted blood flow, leading to hypoperfusion and infarction.

Area of Science:

  • Vascular anatomy
  • Neurology
  • Radiology

Background:

  • Persistent primitive proatlantal intersegmental artery (PPPIA) is a rare congenital vascular anomaly.
  • Understanding its variations is crucial for diagnosing cerebrovascular events.

Observation:

  • A 65-year-old male presented with acute stroke symptoms, including dysarthria and hemiparesis.
  • Imaging revealed cerebral infarction and a prominent anastomosis between the external carotid and vertebral arteries at the proatlantal region.
  • The patient's vertebro-basilar system circulation was solely dependent on this anomalous artery, with hypoplasia of the native vertebral arteries.

Findings:

  • Digital subtraction aortography and CT angiography confirmed the PPPIA as the sole supply to the posterior circulation.
  • 133Xe SPECT revealed hypoperfusion in the left middle cerebral artery territory.
  • Associated hypoplasia of the left transverse foramina in cervical vertebrae (C2-C6) was noted.

Implications:

  • This case highlights PPPIA as a potential cause of ischemic stroke, particularly in the anterior circulation territory.
  • The findings suggest a long-standing "blood-stealing" phenomenon from anterior to posterior circulation via the PPPIA.
  • Recognition of PPPIA is vital for accurate stroke etiology diagnosis and management strategies.

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