Isolated intermittent vertigo: A presenting feature of persistent trigeminal artery

Area of Science:

• Neurology
• Vascular Neurology
• Neuroanatomy

Background:

• Persistent embryonic carotid-basilar anastomosis, such as the persistent trigeminal artery, can lead to diverse neurological symptoms in adulthood.
• Understanding these anatomical variations is crucial for diagnosing and managing cerebrovascular conditions.

Observation:

• A 76-year-old male presented with isolated intermittent vertigo and symptoms mimicking anterior and posterior circulation strokes.
• The patient had a persistent left trigeminal artery and significant (75%) stenosis of the left internal carotid artery (ICA).
• Impaired vasomotor reactivity was noted in the anterior and posterior cerebral arteries.

Findings:

• The patient's intermittent vertigo resolved following carotid endarterectomy.
• Decreased blood flow through the stenotic left ICA likely caused basilar artery insufficiency.
• Hypoperfusion of the flocculonodular lobe, supplied by the anterior inferior cerebellar artery, is proposed as the cause of vertigo.

Implications:

• This case underscores the clinical significance of persistent trigeminal artery in the context of internal carotid artery stenosis.
• Effective management of carotid stenosis can alleviate neurological symptoms attributed to vertebrobasilar insufficiency.
• Further research into the neurovascular implications of persistent embryonic anastomoses is warranted.