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Images in Neurology |

Agenesis of Internal Carotid Artery With Unusual Fetal Collateral Circulation

Petar Slankamenac, PhD; Aleksandar Jesic, MD; Zeljko Zivanovic, MD; Ksenija Gebauer-Bukurov, MD; Ksenija Bozic, PhD
Arch Neurol. 2010;67(10):1280-1281. doi:10.1001/archneurol.2010.236.
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A 17-year-old boy experienced 2 transitory ischemic attacks with dysphasia, right hemiparesis, and visual disturbances. At the age of 2 years, he had undergone surgery to repair a complex congenital heart defect consisting of patent ductus arteriosus, patent foramen ovale, and dysplastic pulmonary valve with shunting and pulmonary hypertension. After the surgery, he was regularly observed by his cardiologists; his physical and mental development were normal.

On magnetic resonance angiography the patient's left internal carotid artery was missing, while the right internal carotid artery was hypoplastic (Figure, A). Computed tomography of the temporal bone showed the carotid canal was hypoplastic on the left side, which is highly suggestive of internal carotid artery agenesis (Figure, B). In the circle of Willis, the fetal type of collateral circulation was present, with the left middle cerebral artery supplied with blood from the basilar artery. Furthermore, the anterior communicating artery and both pericallosal arteries were arising from the anterior cerebral artery on the affected left side, while segment A1 was missing on the right (Figure, C). Aneurysms were not found. Echocardiography revealed no cardiac thrombi.

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Imaging of patient's major cranial blood vessels. A, On magnetic resonance (MR) angiography, the left internal carotid artery (ICA) is missing (thin arrows), right ICA present (thick arrow). B, On computed tomography of petrosal bone, the left hypoplastic carotid canal (arrow) displays agenesis of ICA. C, Fetal circulation type A: MR angiography of circle of Willis shows the left middle cerebral artery (thin arrow) arising from the posterior communicating artery (thick arrow). Segment A1 of the right anterior cerebral artery is missing (dotted arrow).

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