Trigeminal neuralgia associated with a variant of persistent trigeminal artery

A persistent trigeminal artery variant (PTAV) is an anomalous vessel that originates from the internal carotid artery and directly supplies the cerebellum without interposition of the basilar artery. This anatomic variant is usually found incidentally on imaging but can rarely have clinical implications. We describe a case of a 74-year-old woman presenting with multiple years of lower jaw pain attributed to trigeminal neuralgia, unresolved with medication. A persistent trigeminal artery variant compressing the trigeminal nerve was identified on magnetic resonance imaging and magnetic resonance angiography. The characteristic imaging findings of PTAV are essential for identifying an etiology of medically refractory trigeminal neuralgia and may assist with preoperative planning.