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Year : 2014  |  Volume : 62  |  Issue : 5  |  Page : 580--581

Angiographic "Tau (τ)" sign in persistent trigeminal artery

Krishnan Prasad1, Eswararao Thamatapu1, Manash Saha2, Sayan Das2,  
1 Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
2 Department of Radiodiagnosis, Peerless Hospital and Bhudeb Kanti Roy Research Centre, Kolkata, West Bengal, India

Correspondence Address:
Krishnan Prasad
Flat 3B, 9 Southend Park, Kolkata - 700 029, West Bengal
India




How to cite this article:
Prasad K, Thamatapu E, Saha M, Das S. Angiographic "Tau (τ)" sign in persistent trigeminal artery.Neurol India 2014;62:580-581


How to cite this URL:
Prasad K, Thamatapu E, Saha M, Das S. Angiographic "Tau (τ)" sign in persistent trigeminal artery. Neurol India [serial online] 2014 [cited 2022 Oct 1 ];62:580-581
Available from: https://www.neurologyindia.com/text.asp?2014/62/5/580/144519


Full Text

Brain magnetic resonance imaging (MRI) of a 44-year-old lady done as part of the evaluation of non-specific headache, revealed a left side vascular anomaly. Neurologic examination was normal. MR-angiogram with Time Of Flight (TOF) sequence showed a persistent trigeminal artery on the left side extending backwards by the side of the sella from the internal carotid artery to the basilar artery [Figure 1]. Coronal T2 and reconstructedimages showed that the artery was joining the basilar trunk below the origin of the superior cerebellar artery [Figure 2]. The vertebrobasilar complex below the union was hypoplastic. Sagittal reconstructions showed that both posterior communicating arteries were absent and "tau" sign was present at the site of origin of the vessel from the internal carotid artery [Figure 3].{Figure 1}{Figure 2}{Figure 3}

Persistent trigeminal artery is an embryological remnant of the anastamosis that existed in fetal life between the developing carotid arteries and the longitudinal neural arteries that go on to make the vertebrobasilar system. [1],[2] Its incidence is reported to be 0.1% to 1% [1] and it isthe commonest (accounting for 85%) [1],[2] of all the fetal carotid basilar anastamosis that may persist- the others being the persistent otic, hypoglossal and proatlantal arteries. [1] Its termination may be in one of 3 ways - anastamosing with the basilar artery below the superior cerebellar artery and supplying both posterior cerebral and superior cerebellar arteries (Saltzman Type 1), anastamosing with the basilar artery below the superior cerebellar artery but supplying only both superior cerebellar arteries and one or both posterior cerebral arteries being supplied by the posterior communicating arteries (Saltzman Type 2) or it may end in one of the cerebellar arteries (Saltzman Type 3). [1],[2],[3],[4] Our case was one of Saltzman Type 1.

The "Tau (τ)" sign is a classic angiographic sign of a persistent trigeminal artery. [5] It is so called because of the visual similarity on sagittal images to the Greek letter "Tau" - the vertical and anterior horizontal limbs of which are formed by the internal carotid arteries and the posterior limb by the persistent trigeminal artery. The only other vessel that may arise in this vicinity from the ICA and course backwards to meet the basilar complex is the otic artery but its origin is lower and also the vertical limb of the ICA can be seen above its the point of origin thereby precluding any cause of confusion.

The existence of the persistent trigeminal artery is often underdiagnosed and underreported . Usually diagnosed incidentally, [1],[2] it may rarely cause cranial neuropathies (like trigeminal neuralgia) [3] and this anomaly must be kept in mind during any surgeries involving this area to prevent iatrogenic injury. [3],[4]

References

1Luh GY, Dean BL, Tomsick TA, Wallace RC. The persistent fetal carotid-vertebrobasilar anastomoses. AJR Am J Roentgenol 1999;172:1427-32.
2Azab W, Delashaw J, Mohammed M. Persistent primitive trigeminal artery: A review. Turk Neurosurg 2012;22:399-406.
3Alcalá-Cerra G, Tubbs RS, Niño-Hernández LM. Anatomical features and clinical relevance of a persistent trigeminal artery. Surg Neurol Int 2012;3:111.
4Pereira LP, Nepomuceno LA, Coimbra PP, Oliveira Neto SR, Natal MR. Persistent trigeminal artery: Angio-tomography and angio-magnetic resonance finding. Arq Neuropsiquiatr 2009;67:882-5.
5Chavhan GB, Shroff MM. Twenty classic signs in neuroradiology: A pictorial essay. Indian J Radiol Imaging 2009;19:135-45.