Persistent trigeminal artery (PTA) can be associated with hypoplasia of the proximal basilar and ipsilatereal vertebral artery. This can predispose adults to posterior circulation ischemia by a low flow state. A 40 year-old male presented with diplopia, dizziness and motor weakness in all extremities. He had no conventional risk factors of ischemic stroke. In brain Magnetic Resonance Imaging (MRI), acute infarction was observed in medulla, pons and cerebellum. PTA was also discovered with hypoplasia of vertebrobasilar system in brain Magnetic Resonance Angiography (MRA).