Bilateral persistent trigeminal arteries associated with cerebral aneurysms and aortic arch vessel anomaly

We present the case of a patient with headache who, on computed tomography, was found to have subarachnoid hemorrhage. Angiography revealed bilateral persistent trigeminal arteries, anterior communicating artery and left pericallosal artery aneurysms, and an absent left vertebral artery. An anomalous right subclavian artery, originating at a common trunk with the left subclavian artery, was also present. To our knowledge, this is the fifth case of bilateral persistent trigeminal arteries and the sixth case of bilateral persistent carotid-basilar anastomosis of any type reported in the literature. A mechanism for the pathogenesis of multiple cerebrovascular anomalies is briefly discussed.