Presentation
Irresponsive, vomited.
Patient Data
Non-contrast CT head
Small chronic infarct in the right frontal superior gyrus.
CTA head and neck
Hypoplastic left vertebral artery (LVA), disappearing at the level of the C4 vertebra. The intracranial segment (V4) is seen as a continuation of a prominent branch of the left external carotid artery (LECA), together comprising a proatlantal artery.
The rest of the neck and brain arteries are patent and of normal appearance and caliber.
3D reformation showing the proatlantal artery (PAA) to be a prominent branch of the left ECA that enters the foramen magnum to supply/continue as the left intracranial vertebral artery (lt V4).
Case Discussion
Incidental finding of a proatlantal artery - type II (i.e. originating from the external carotid artery (ECA)), associated with an ipsilateral hypoplastic vertebral artery.
Interestingly, the posterior auricular artery (small transparent artery snaking behind the mastoid process in the 3D reformation) branches from the proatlantal artery, not from the ECA itself.
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