Reversible ophthalmoplegia associated with ipsilateral persistent primitive trigeminal artery: A case report

Persistent primitive trigeminal artery (PPTA) is a rare congenital carotido-basilar anastomosis which may be associated with several different cranial nerve deficits and intracranial vascular insults. We presented a 79-year-old hypertensive male patient of acute unilateral ophthalmoplegia but without abnormal pupillary light reflex, headache, or facial pain. Magnetic resonance imaging (MRI) showed "extra" flow void channel along a tortuous and dilated cavernous portion of left internal carotid artery (ICA). Cerebral angiography confirmed the presence of an ipsilateral elongated and tortuous persistent primitive trigeminal artery with a posterolateral course. His symptoms remitted spontaneously in 2 months with only better control of hypertension but no other specific treatment. Possible pathogenesis, treatment and further non-invasive diagnostic procedures are discussed.