Transient bilateral occipital lobe ischemia: microembolization through a trigeminal artery

Area of Science:

• Neurology
• Vascular Surgery
• Neuroimaging

Background:

• Cerebrovascular disease can lead to transient or permanent neurological deficits.
• Carotid artery stenosis is a significant risk factor for ischemic stroke.
• Anatomical variations, such as a persistent trigeminal artery, can alter cerebral blood flow patterns.

Observation:

• A patient presented with episodic bilateral central scotomata, indicating visual disturbances.
• Imaging revealed microembolization originating from an ulcerated carotid artery.
• The emboli traveled to both occipital lobes through an unusual pathway involving a persistent trigeminal artery.

Findings:

• This case demonstrates a unique embolic pathway from the carotid artery to the posterior circulation via a persistent trigeminal artery.
• The microembolization resulted in occipital lobe ischemia, explaining the patient's visual symptoms.
• The pathway described has not been previously reported in medical literature.

Implications:

• Understanding rare cerebrovascular pathways is crucial for accurate diagnosis and treatment of ischemic events.
• This case highlights the importance of considering anatomical variations in patients with atypical stroke presentations.
• Successful intervention with carotid endarterectomy suggests this approach may be beneficial in similar unique embolic scenarios.