Bilateral Internal Carotid Artery Agenesis : Very Rare Cause of Bilateral Pulsatile Tinnitus

Abstract

Bilateral internal carotid artery agenesis is a very rare congenital anomaly. Intracranial blood circulation in the affected internal carotid artery side is provided by collateral vasculature, contralateral internal carotid artery through the anterior communicating artery, and from the vertebrobasilar system through the posterior communicating artery. People with this abnormality may be asymptomatic for many years. However, patients may also be present with ischemic stroke or subarachnoid hemorrhage, headache, and blurred vision. Diagnosis is usually incidental by the performance of carotid artery doppler ultrasonography or cervical/cranial magnetic resonance imaging owing to other symptoms. We report a case of bilateral internal carotid artery agenesis with pulsatile tinnitus lasting five years in the light of clinical presentation and imaging findings.