title: Recurrent horner syndrome and persistent trigeminal artery.
abstract: BACKGROUND
  A persistent primitive trigeminal artery (PTA) is the most common type of fetal carotid-basilar anastomosis in adulthood; however, its prevalence is low and estimated between 0.1% and 0.7% in angiographic studies. PTA is usually diagnosed incidentally during an angiographic examination, though some symptomatic cases associated with cranial nerve dysfunction have been described. We describe the unusual association between PTA and ipsilateral Horner syndrome triggered by hypertensive crisis.
  
  
  METHODS
  A 40-year-old man presented to medical attention for recurrent episodes, over the last 3 years, characterized by hypertensive crisis (up to 220/150 mm Hg), dizziness, tachycardia, flushing of the forehead on the left side, ptosis, miosis, and conjunctival injection of the left eye without pain. Imaging revealed a left PTA originating from the carotid siphon with moderate ectasia of the proximal tract. We speculate that the recurrent Horner syndrome observed in our patient could be due to the disruption of the postganglionic peripheral fibers in the pericarotid plexus. Adequate antihypertensive therapy led to resolution of signs and symptoms.
  
  
  CONCLUSIONS
  To our knowledge, we present the first case of persistent PTA and ipsilateral Horner syndrome during hypertensive crisis. Adequate antihypertensive therapy can be useful in patients bearing trigeminal artery variants.
authors.affiliation: Neurological Department, A. Manzoni Hospital, Lecco, Italy. rig74@libero.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Rigamonti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lauria
authors.forename: Valentina
authors.initials: V
authors.lastname: Prone
authors.forename: Chiara
authors.initials: C
authors.lastname: Fumagalli
authors.forename: Marco
authors.initials: M
authors.lastname: Longoni
authors.forename: Roberto
authors.initials: R
authors.lastname: Balgera
authors.forename: Elio
authors.initials: E
authors.lastname: Agostoni
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001488:Basilar Artery / Q000503:physiopathology*; D002343:Carotid Artery, Internal / Q000503:physiopathology*; D006732:Horner Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents