An Interesting Case with Recurrent Ischemic Attacks; A New Conception for Brain Blood Supply

Bilateral extracranial internal carotid artery occlusion is a rare cause of transient ischemic attacks and stroke. In this situation, usually posterior circulation is the main source of brain blood supply. Insufficient posterior circulation with bilateral internal carotid artery is scarce, and its clinical picture in this condition is unpredictable. A 64-years-old man was admitted with recurrent transient ischemic attacks as hemiparesis (right hemiparesis except for one which left hemiparesis). Evaluations disclosed bilateral extracranial internal carotid artery occlusion accompanied with hypoplastic left vertebral artery and about 90% of stenosis in right vertebral artery as a main source of brain blood supply. This is a rare of case stenotic right vertebral artery as the only source of anterior and posterior brain blood supply, in absence of persistent neurologic sign, that has not been reported by now.