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On admission, he was found to have abnormal blood pressure (150/90 mmHg; 1 mmHg = 0.133 kPa) and low‐density lipoprotein level (3.8 mmol/L). Cranial magnetic resonance imaging (MRI) showed multiple ischemic lesions under both frontal cortices. Common carotid angiograms showed symmetrical anomalies in both external carotid arteries. The facial, lingual, and superior thyroid arteries arose from the ipsilateral common carotid artery [Figure 1a and 1b]. Right internal carotid angiogram showed complete occlusion of the right middle cerebral artery and the formation of moyamoya vessels in the basal ganglia and a persistent primitive trigeminal artery (PPTA) that branched from the C4 portion of the right internal carotid artery and terminated at the upper portion of the basilar artery [Figure 1c]. Left internal carotid angiogram revealed occlusion of the left middle cerebral artery and the formation of a few moyamoya vessels [Figure 1d]. Left vertebral artery angiogram showed that the posterior circulation system provided the compensatory blood supply to the anterior circulation through bilateral posterior communicating arteries and distal cortical branches [Figure 1e]. Computed tomography angiography also revealed the incidental finding of an associated fenestration of the basilar artery [Figure 1f]. The patient was treated conservatively with medications and was discharged two weeks later. His symptoms have not recurred during the follow‐up period of one year.

A Rare Case of Persistent Primitive Trigeminal Artery with Multiple Anomalies of Cerebral Vessels