The fetal posterior cerebral artery (f-PCA) is an anatomical variant of the circle of Willis, which was correlated with ischemic stroke, either ipsilateral, or controlateral. We present the case of a male 82-year old patient, who was admitted in the emergency care unit of the “Prof. Dr.N.Oblu” Emergency Clinical Hospital, Iasi, for a transient ischemic attack. The patient presented several comorbidities such as diabetes mellitus, hypertension stage 2, renal hydronephrosis, atrial fibrillation, and ischemic cardiomyopathy. His first submission to the emergency unit in 2014 had been due to an episode of transient ischemic attack, but after one year of not respecting his treatment and not willing to engage enough in occupational therapy procedures, he developed a second stroke, this time a large one, with secondary reperfusion, which lead to patient's death in a short time from his admission in our hospital. The autopsy revealed an asymmetrical circle of Willis due to the presence of a left fetal PCA and right hypoplastic posterior communicating artery (PComA) and a brain infarction with reperfusion of in the territory of the right PCA. Data from literature regardingthis particular type of paradoxal stroke and the coexistence of the two anatomical variants in the circle of Willis has been researched with the selection of 13 significant articles published in the period of the last 20 years.