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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
Summary
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.