Bilateral congenital absence of the internal carotid arterie
The present case report has been published in the journal Radiology Case Reports.

A 52-year-old female presented for a routine follow-up appointment related to her bilateral elevated optic discs and residual left optic neuropathy. She had constant headache, especially when laying down flat. A computed tomography angiography (CTA) of her head and neck was done.

While inspecting the major branches of the aorta in the neck, the right common carotid originated from the brachiocephalic trunk and the left common carotid artery arose from the arch of the aorta. However, there was no bifurcation of the common carotid arteries at the expected level superior to the thyroid cartilage.

The vessels identified in this area were determined to be the external carotid arteries as they followed the appropriate anatomical course and had the expected branches in the neck with no intracranial extension. The expected course of the intracervical and intracranial portions of the ICA failed to demonstrate any visible vessels.

Additionally, petrous carotid canals were not identified on either side. These findings were representative of bilateral absence of the ICAs. The CTA head revealed patent anterior cerebral circulation, which was found to be from compensatory enlarged feeding posterior communicating arteries (PCOM), prominent basilar artery, posterior cerebral arteries (PCA) and codominant enlarged vertebral arteries. This patient also had hypoplastic left internal jugular vein, sigmoid, and transverse sinuses.

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