The identification of the PTA is aided by specific imaging characteristics, particularly on CT angiography (CTA) or magnetic resonance imaging (MRI), where it can be distinguished by unique signs such as the "tau sign" or the "trident sign." These imaging features provide critical clues that differentiate the PTA from other vascular entities and help guide accurate diagnosis.

The presence of a PTA is associated with a range of clinical conditions, most notably vascular anomalies and neurological disorders. For instance, there is a recognized association between the PTA and intracranial aneurysms. The altered hemodynamics associated with this variant can predispose individuals to aneurysm formation in the circle of Willis or other locations, potentially leading to life-threatening complications if not identified and managed promptly.

Trigeminal artery-cavernous fistulas are another notable condition linked with the PTA. These abnormal connections between arteries and veins within the cavernous sinus region can result in altered blood flow dynamics, leading to symptoms such as pulsatile tinnitus, visual disturbances, or proptosis. Clinical vigilance for these symptoms in the presence of a PTA can prompt timely investigation and management, potentially preventing more severe outcomes.

Additionally, the PTA may act as a conduit for embolic material from the anterior to posterior cerebral circulation. This capability raises the risk of posterior circulation strokes, characterized by symptoms such as vertigo, ataxia, and visual field deficits. In such cases, recognizing the PTA's presence can provide crucial context for the clinical picture and influence treatment decisions, such as the administration of anticoagulant or antiplatelet therapies.

One of the more common neurological implications of a persistent trigeminal artery is neurovascular compression of the trigeminal nerve. This can lead to trigeminal neuralgia, a condition characterized by episodes of intense facial pain that can be triggered by activities as benign as brushing one's teeth or chewing. Understanding the PTA's relationship with the trigeminal nerve is essential for devising effective treatment strategies, potentially involving surgical interventions to alleviate compression.

The detection of a PTA relies heavily on advanced imaging techniques. CTA and MRI are particularly valuable in visualizing the vascular architecture of the brain, with specific sequences and planes designed to highlight arterial features. Radiologists must be familiar with the typical presentations of a PTA and the potential for its mimicking other structures. An accurate diagnosis prevents misinterpretation and ensures appropriate clinical follow-up.