Bilateral intracranial arterial aneurysms with a persistent trigeminal artery

Area of Science:

• Neurology
• Vascular Neurology
• Neuroanatomy

Background:

• Persistent trigeminal artery is a rare fetal remnant of the primitive trigeminal artery, typically regressing during fetal development.
• The Circle of Willis, a critical arterial anastomosis in the brain, forms through complex embryologic processes.
• Variations in Circle of Willis development can lead to persistent fetal arteries and associated vascular anomalies.

Observation:

• A 62-year-old hypertensive female presented with painless ophthalmoplegia.
• Imaging revealed bilateral intracranial arterial aneurysms.
• The patient also had a persistent trigeminal artery, a rare vascular variant.

Findings:

• The co-occurrence of intracranial aneurysms and persistent trigeminal artery suggests a potential developmental link.
• Embryologic review supports the persistent trigeminal artery as a consequence of incomplete regression of fetal vasculature.
• A high incidence of associated vascular malformations is noted with persistent trigeminal artery.

Implications:

• Understanding the embryogenesis of the Circle of Willis is crucial for explaining persistent trigeminal artery occurrence.
• This case underscores the importance of considering associated vascular malformations in patients with persistent trigeminal artery.
• Further research into the genetic and developmental factors underlying these vascular anomalies is warranted.