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Brainstem Infarction Secondary to Persistent Trigeminal Artery Occlusion: Successful Treatment with Intravenous rt-PA

A 70-year-old man with atrial fibrillation developed dysarthria and right hemiparesis. While he received intravenous rtPA (0.9 mg/kg), diffusion-weighted MRI and MR angiography showed an acute left pontine infarction ( fig. 1 a) and embolic occlusion of the persistent trigeminal artery (PTA) ( fig. 1 b). His neurological deficits rapidly improved and CT angiography 7 h after the therapy showed reperfused basilar artery (BA) through the PTA ( fig. 1 c). PTA is a persistent embryonic connection between the cavernous part of the internal carotid artery and the BA. Brainstem ischReceived: July 22, 2010 Accepted: September 21, 2010 Published online: November 6, 2010