A persistent primitive trigeminal artery (PPTA) is the most common of the embryonic carotid–basilar anastomoses that remain into adulthood; an incidence of 0.1–1.0% has been reported.¹ Although typically an incidental finding on angiogram or non-invasive vascular imaging, the condition has been found in association with trigeminal neuralgia² and various vascular anomalies. We present imaging from a patient with acute ischaemia in the setting of a PPTA that is presumed to be embolic along the distribution of this anastomosis.

A 54-year-old man with undiagnosed diabetes and hyperlipidaemia presented to our …