CASE REPORT: PERSISTENT PROATLANTAL INTERSEGMENTAL ARTERY

*Jehad Al-Habsi, MD and Sharad S. Rajamani, MCh, FICS, FAVNS, FEBNS, PhD

ABSTRACT

Background: Remnants of fetal carotid-basilar circulation are rarely identified. Usually, they are asymptomatic and incidentally found on imaging. A case of proatlantal intersegmental artery diagnosed during angiography for an arteriovenous malformation is described. History, embryological development, and anatomy of the proatlantal intersegmental artery are reviewed. Case Report: A 13-year-old boy was brought to the emergency services with a history of sudden onset headache associated with loss of consciousness and then vomiting. Computed tomography (CT) scan showed intraventricular bleeding in the lateral ventricles extending to the fourth ventricle associated with dilatation. Digital Subtraction Angiography (DSA) showed an AVM in the temporal periventricular region, Spetzler Martin grade 3. The patient underwent embolization in the same sittings. Incidentally, It was found a shunting of blood from the ascending pharyngeal to the vertebral artery at the CV Junction was seen. This is representing a type 2 PPIA. Conclusions: Most proatlantal intersegmental arteries are found incidentally. Understanding anomalous vascular anatomy such as persistent carotid-vertebrobasilar anastomoses, and the associated anatomical variations, is very essential in planning head and neck surgeries.

Keywords: Persistent proatlantal intersegmental artery, proatlantal intersegmental artery, neurosurgery, anatomy, case report, vascular.