A case of Coexistent Persistent Trigeminal and Hypoglossal Arteries Manifested with Neurovascular Compression Syndrome by Hypertension

Abstract

A 70-year-old woman visited our hospital with hypertension, diplopia, and right orbital pain. Neurological examination revealed right ophthalmoplegia. CT angiography and MRI identified a right persistent trigeminal artery (PTA), right persistent hypoglossal artery, and bovine aortic arch. The right internal carotid artery (ICA) was displaced laterally in the cavernous sinus due to the bifurcation of the PTA. Compression of the right oculomotor nerve, right trochlear nerve, and first division of the right trigeminal nerve by the elongated right ICA was noted and considered a potential cause of the ophthalmoplegia and orbital pain. Symptoms improved with normalization of blood pressure. During embryonic development, the right posterior communicating artery and bilateral vertebral arteries were aplastic or hypoplastic, which suggests that these carotid-basilar anastomoses may have remained as supply routes to provide sufficient blood flow to the posterior cerebral circulation. This is an extremely rare case of embryological implications manifested with neurovascular compression syndrome. (Received 6 January, 2022; Accepted 17 February, 2022; Published 1 June, 2022).