Association of tetralogy of Fallot with multiple variations of the cerebral arteries diagnosed by magnetic resonance angiography

Tetralogy of Fallot very rarely manifests with variations of the cerebral arteries, but we detected an extremely rare combination comprising 3 such variants –bilateral carotid–anterior cerebral arteries anastomoses, the vertebral–anterior inferior cerebellar arteries anastomosis (proximal basilar artery duplication) and a nonbifurcating cervical carotid artery– in a 19-year-old man during magnetic resonance angiography to evaluate syncope. Recognition and correct diagnosis of these variations are crucial prior to surgical or radiological cerebrovascular intervention. Both partial maximum-intensity-projection images and source images are useful in identifying these vessels on MR angiography.