Abstract
We report the case of a 56-year-old man with acute onset of de-novo stabbing, pulsating and diffuse headache with subsequent appearance (within few minutes) of posterior fossa symptoms (vomiting, postural instability, anisocoria, incoordination, dysarthria, retropulsion) lasting 9–12 h. Recurrent hypertensive crises were detected during the acute observation in the Emergency Room, even in the absence of previous history of hypertension. Once subarachnoid hemorrhage and focal lesions (vascular and non-vascular) were excluded, brain computerized tomography-angiography and digital subtraction angiography disclosed the presence of left persistent primitive hypoglossal artery with bilateral vertebral artery hypoplasia and a slight aneurysmal dilation of the anterior communicating artery. Brain magnetic resonance study performed 24 h after onset of symptoms was negative for recent ischemic lesions. The clinical features of this rare vascular condition are discussed as a possible cause of magnetic resonance (diffusion weighted imaging) negative vertebro-basilar transient ischemic attack.
Highlights
We report the case of a 56-year-old man with acute onset of de-novo stabbing, pulsating and diffuse headache with subsequent appearance of posterior fossa symptoms lasting 9–12 h
Once subarachnoid hemorrhage and focal lesions were excluded, brain computerized tomographyangiography and digital subtraction angiography disclosed the presence of left persistent primitive hypoglossal artery with bilateral vertebral artery hypoplasia and a slight aneurysmal dilation of the anterior communicating artery
In order to investigate the vertebro-basilar (VB) district, the patient underwent urgent brain computerized tomography (CT)-angiography with maximum intensity projection (MIP), multiplanar (MP) and three-dimensional (3D) reconstructions, with the detection of left persistent primitive hypoglossal artery (PPHA) as a large vessel originating from the internal carotid artery (ICA) at the C2 vertebral level, entering the posterior cranial fossa through an enlarged hypoglossal canal and joining the lower portion of the basilar artery (Fig. 1)
Summary
Abstract We report the case of a 56-year-old man with acute onset of de-novo stabbing, pulsating and diffuse headache with subsequent appearance (within few minutes) of posterior fossa symptoms (vomiting, postural instability, anisocoria, incoordination, dysarthria, retropulsion) lasting 9–12 h.
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