Brainstem infarction in a patient with internal carotid diss
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Several fetal anastomoses have been described between the carotid and vertebrobasilar circulations. These anastomoses regress while the P1 segments develop, but they can occasionally persist in adult age. The primitive trigeminal artery (PTA) is the most common of them representing about 85% of cases with prevalence between 0.1% and 0.76%. We report a patient with brainstem infarction caused by a persistent PTA thrombosis secondary to occlusive dissection of the homolateral internal carotid artery (ICA). A 42-year-old woman presented with the right-side motor deficit and dysarthria. She experienced diffuse headaches, regressive episodes of ill-defined visual disturbance and right-side numbness the previous day. She reported osteopathic cervical manipulations in the previous week.Neurologic examination revealed right-sided hemiparesis, hypoesthesia, central facial palsy, and dysarthria. No Horner's sign, cranial nerve palsy, abnormal cardiac or carotid bruit was found.Magnetic resonance imaging (MRI) revealed left anterolateral pontine infarction.

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