Congenital absence of internal carotid artery: an unsuspected diagnosis

Description

A man aged 56 years, with a history of moderate sensorineural hearing loss, presented with a fast progressing loss of hearing discrimination in his right ear. The audiogram confirmed the moderate sensorineural hearing loss with a speech discrimination drop from 90% on the previous audiogram to 30%.

An MRI of the brain revealed an absence of the right internal carotid artery (ICA). No signs of acute or chronic ischaemic changes were found in the brain parenchyma. Subsequently, a cervical and intracranial MR angiogram was performed, which revealed a complete absence of the right ICA and the first segment (A1) of the anterior cerebral artery (ACA) from ICA to the anterior communicating artery (figure 1). Both ACA arise from the left ICA. A CT scan of the brain and a CT angiogram of the supra-aortic arteries revealed a thinner common CA ending at the external CA (

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