Persistent Hypoglossal Artery Research Articles

When Carotid Artery Stenosis Cause Posterior Fossa Infarct. An Unusual Case of Persistent Hypoglossal Artery.

The primitive anastomosis between the carotid artery and the vertebrobasilar arteries usually regress, in rare cases they persist beyond fetal development and form vascular anomalies such as primitive persistent hypoglossal artery(PPHA), with prevalence of 0.02-0.1% in the general population. A 77-year-old female presented with aphasia, weakness of both legs and arms. Computed Tomography Angiography (CTA) revealed subacute infarct in right pones, severe stenosis of the right internal carotid artery(RICA) and ipsilateral PPHA. We performed Right carotid artery stenting (CAS) using a distal filter into the PPHA to protect the posterior circulation, with good result. The posterior circulation was utterly dependent on the RICA, therefore, despite the general notion that carotid stenosis is usually associated with anterior circulation infarcts, in cases having vascular anomalies it may cause a posterior stroke. Carotid artery stenting offer a safe and simple solution, however the use of EPD requires special considerations regarding decision on the suitable protection technique and placement. Neurological symptoms in the presence of carotid artery stenosis and PPHA can manifest as ischemia of the anterior and/or the posterior circulation. In our opinion, CAS gives a simple and safe treatment solution.

Benign paroxysmal positional vertigo in a patient with persistent hypoglossal artery and bilateral madelung deformity

We explore a case of Benign Paroxysmal Positional Vertigo in the context of Persistent Hypoglossal Artery (PHA) and bilateral Madelung Deformity (MD). PHA is associated with a raft of major adverse cardiovascular events. MD can result from manifold conditions such as Turner's Syndrome and mesomelic dwarfism. In this case, the patient's positive family history of MD across generations is suggestive of inherited mutation in the Short Stature Homeobox (SHOX) Gene. We discuss the putative impact of SHOX on the genesis of Benign Paroxysmal Positional Vertigo (BPPV) in a patient with PHA and bilateral MD.

Case of Amaurosis Fugax in the Setting of a Persistent Primitive Hypoglossal Artery Requiring Carotid Endarterectomy with Regional Anesthesia.

BACKGROUND A persistent primitive hypoglossal artery (PPHA) is a rare congenital anomaly leading to persistent carotid-basilar anastomosis. This is a report of an 83-year-old man with a PPHA presenting with amaurosis fugax of the left eye requiring carotid endarterectomy under regional anesthesia. CASE REPORT An 83-year-old man presented with 2 weeks of intermittent self-resolving visual disturbances, followed by an episode of left eye amaurosis fugax. The patient had been referred to the hospital for further investigation of symptoms 1 day following the amaurosis fugax event. Carotid Doppler ultrasound demonstrated a greater than 90% stenosis of the left internal carotid artery. Computed tomography carotid and Circle of Willis angiography confirmed a mixed, ulcerated plaque and revealed a persistent left hypoglossal artery originating from the left internal carotid artery and continuing as the basilar artery. On day 3 of admission, left carotid endarterectomy was performed under conscious sedation and regional anesthesia to permit continuous monitoring of neurological status and avoid the need for intraoperative shunting. "Permissive hypertension" by targeting a systolic blood pressure of 190 to 200 mmHg was sought for the duration of clamp time. There was no deterioration of neurological function during clamping of the carotid vessels. The patient recovered well and was discharged 2 days after surgery, with no residual neurology. CONCLUSIONS This report has presented a rare case of PPHA to highlight awareness of this congenital vascular anomaly when undertaking carotid endarterectomy.

Right Posterior Cerebral Infarction in the Setting of Carotid Atheromatous Disease with a Persistent Primitive Hypoglossal Artery

A 59 year old woman presented with left arm paraesthesia and dizziness due to right posterior cerebral infarction. Computed tomography angiography showed an atherosclerotic focal stenosis (80% on duplex ultrasonography) of the right carotid bifurcation and a persistent hypoglossal artery (HA) originating at the C2 level of the right internal carotid artery (ICA). The aberrant artery (prevalence 0.02%–0.09%) passed through the hypoglossal canal, continuing as the basilar artery (BA). The vertebral arteries were hypoplastic; the left vertebral artery (LVA) originated from the aortic arch and gave rise to a cerebellar terminal network. Right carotid endarterectomy was performed with full recovery.Image 1

Is a trident or a bident? Appearance of a primitive trigeminal artery on sagittal views

•Recognition of a persistent primitive trigeminal artery (PPTA) is of clinical significance due to its association with aneurysms and several vascular variants in addition to preoperative planning.•Characteristic appearance of PPTA on MR sagittal images of the brain resembles the Greek letter tau (two prongs) and was linked to Neptune’s trident (three prongs).•Use of a bident sign as a more visually and mythologically precise description of the appearance of PPTA. A 50 year old male with an incidental finding on the MRI brain (Fig. 1).Fig. 2A) Lateral digitally subtracted catheter angiogram of a selected internal carotid artery (arrow) injection demonstrating the persistent trigeminal artery (arrowhead) passing posteriorly to join the basilar artery (open arrow). B) Cropped view of the painting “Concilio degli dei” by Raffaello Sanzio da Urbino depicting Hades holding a bident (left), next to his brother Poseidon holding a trident (middle) [10]. Zeus (right) is also pictured, without a spear.View Large Image Figure ViewerDownload Hi-res image Download (PPT) A.fetal posterior cerebral arteryB.persistent trigeminal arteryC.persistent hypoglossal arteryD.persistent otic arteryE.persistent proatlantal artery Answer on page 240 Is a trident or a bident? Appearance of a primitive trigeminal artery on sagittal viewsJournal of Clinical NeuroscienceVol. 75PreviewA persistent primitive trigeminal artery (PPTA) is the remnant of the embryonic arterial circulation in adults and is the most common type of the persistent carotid-vertebrobasilar anastomoses (with frequency 0.1–0.6%); followed by persistent hypoglossal artery (0.02–0.1%), persistent proatlantal artery and otic artery, which existence, however, remains controversial [6,7]. A PPTA arises from the proximal cavernous part of the ICA and courses posteriorly to join the basilar artery. Recognition of a PPTA is of clinical significance due to its association with aneurysms and several vascular variants [1,4]. Full-Text PDF Erratum to “Is a trident or a bident? Appearance of a primitive trigeminal artery on sagittal views – Question and Is a trident or a bident? Appearance of a primitive trigeminal artery on sagittal views – Answer” [J. Clin. Neurosci. 75C (2020) 204–205 and 240–241]Journal of Clinical NeuroscienceVol. 78PreviewThe publisher regrets to inform readers that there was an error in the article title for both the question and answer articles. The correct title is ‘Is it a trident or a bident? Appearance of a persistent primitive trigeminal artery on sagittal views – Question’ and ‘Is it a trident or a bident? Appearance of a persistent primitive trigeminal artery on sagittal views – Answer’ respectively. Full-Text PDF

Carotid-vertebrobasilar anastomosis: magnetic resonance and computed tomographic angiographic demonstration.

Carotid-vertebrobasilar (VB) anastomoses are rare and usually found incidentally, but they can have clinical significance. Their variance can represent aneurysm formation at the origin of the anomalous artery, cerebral ischemia due to unique blood flow, or other complications. Thus, recognition and correct diagnosis of these anomalous vessels are important when interpreting magnetic resonance (MR) and computed tomography (CT) angiography. This pictorial essay presents MR and CT angiographic images of several types of persistent fetal carotid-VB anastomoses, including those involving the proatlantal, hypoglossal, and trigeminal arteries as well as their variants. Images depict types 1 and 2 proatlantal arteries, persistent second cervical intersegmental artery, persistent hypoglossal artery (PHA), PHA of external carotid origin, two types of the PHA variant, posterior inferior cerebellar artery arising from the jugular branch of the ascending pharyngeal artery, lateral and medial types of persistent trigeminal arteries (PTAs), and four types of PTA variants.

Abstract TP255: Assessment of Hemodynamic Changes in Persistent Carotid-Vertebrobasilar Anastomoses by Ultrasonography

Objectives: Persistent carotid-vertebrobasilar anastomoses (PCVBA) is a rare cerebral arterial variant between anterior and posterior circulation. This study aimed to evaluate the hemodynamic characteristics of PCVBA by the combination of color Doppler flow imaging (CDFI) and transcranial color-coded sonography (TCCS). Methods: Patients diagnosed with PCVBA were imaged by combination of CDFI and TCCS, then confirmed by digital subtraction angiography (DSA) or computed tomography angiography (CTA) from July 2015 to July 2017. The parameters, including peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI), were acquired in extracranial vertebral artery (VA), intracranial VA, basilar artery and posterior cerebral artery. The vessel diameter of the extracranial VA was measured as well. Results: A total of 14 patients were analyzed in this study. Posterior ischemic stroke associated with ipsilateral internal carotid artery (ICA) atherosclerosis were found in 3 patients (3/14, 21.4%), and posterior transient ischemic attack occurred in 8 patients (8/14, 57.1%). Persistent trigeminal artery (PTA) was confirmed in 6 cases, which the PSV decreased but RI increased in bilateral VA, meanwhile normal velocity was acquired in BA. After compressing the ipsilateral CCA, velocities of BA and bilateral PCA decreased significantly. There were 5 persistent hypoglossal artery (PHA) and 3 proatlantal intersegmental artery (PIA). Among these patients, CDFI displayed a tiny-lumen with reduced PSV and increased RI in bilateral VA. TCCS showed normal velocity in ipsilateral intracranial VA and BA, which were significantly reduced after compressing the ipsilateral CCA. Conclusions: PCVBA may cause the posterior circulation ischemia, especially in patients associated with ipsilateral ICA atherosclerotic lesions. The abnormal hemodynamic changes in different types of PCVBA could be evaluated by combination of CDFI and TCCS.

Persistent hypoglossal artery aneurysm: Case report and qualitative systematic review

A persistent hypoglossal artery was first described in 1889 and is one of the more common anatomical variations arising from aberration in normal development. Endovascular coiling has been recognised as a robust treatment for acutely ruptured intracranial arterial aneurysms, although specific data regarding an aneurysm arising from a persistent hypoglossal artery is lacking due to the low incidence. Here we report both the oldest patient reported to be treated with a persistent hypoglossal artery-associated aneurysm and also explicitly report endovascular treatment of a persistent hypoglossal artery aneurysm arising at the posterior inferior cerebellar artery origin. Qualitative systematic review of the available medical literature demonstrates limited evidence regarding treatment of persistent hypoglossal artery-associated aneurysms with the majority being carried out via open surgery. Ruptured posterior inferior cerebellar artery aneurysm arising from a persistent hypoglossal artery can be successfully and safely treated by endovascular therapy via the persistent hypoglossal artery. Randomised study of this situation is unlikely to be feasible; however, qualitative review of the literature reveals six such aneurysms that have been treated surgically, and this case appears to be the first via an endovascular means.

P.103 Persistent primitive hypoglossal artery with an associated posterior circulation aneurysm

Background: Persistent fetal carotid-vertebrobasilar anastomoses are rare, with an incidence of <1%. The most common anomaly seen in this group is a persistent primitive trigeminal artery; others such as a persistent hypoglossal artery account for less than 15% of all persistent fetal anastomoses, making this finding exceedingly rare. Methods: We present the case of a 32-year-old-female with Poland syndrome (right-sided), who presented with thunderclap headache and reduced level of consciousness secondary to diffuse subarachnoid hemorrhage and hydrocephalus. CT and catheter angiography demonstrated an aneurysm of the V4 segment of the right vertebral artery arising from a persistent right hypoglossal artery, with an absent ipsilateral vertebral artery proximal to the anomaly. Results: Hydrocephalus was treated with an EVD, followed by a successful embolization of the V4 aneurysm with Axium coils. Subsequent MR studies demonstrated minimal recanalization of the aneurysm, and small foci of possible infarcts in the hippocampi. Four months later, the patient has some persistent short term memory difficulties but is otherwise neurologically intact. Conclusions: We present a rare finding of a persistent fetal hypoglossal artery with an associated vertebral aneurysm. The aneurysm was successfully treated endovascularly through coil embolization with minimal residual -neurological deficit. This vascular anomaly was ipsilateral to her Poland Syndrome defects.

The radiology and cerebral vascular insufficiency subject-A case report and literature review

Magnetic Resonance (MR) uses many exam of medical image field. In this case report, we found an interesting case. We did not call it as patient because she did not present any symptoms, thus we call it as subject. Natural cerebral vascular deficiency was seldom to be reported due to subject does not present any obvious symptoms when subject is health or young. Hope that this case report would increase we know more about the congenital part cerebral vascular deficiency. A 36 y old female, who come to our hospital for advanced medical health examination. On the regular radiology exam, the MRI showed she has a congenital part cerebral vascular deficiency on December in 2013. In general, main cerebral artery deficiency would cause some impact on physiological, however, its seemly does not affect her in daily or intelligent working, or we still not know would it affect to human. This case report showed a young women persistent hypoglossal artery was missing. We should continuous follow the subject by regular medical health examination. For her, we can prevent further congenital caused injuries. It also added a rare case of Taiwanese in medical imaging academic field.

Persistent Hypoglossal Artery and Proatlantal Intersegmental Artery, Case Report and Review

Persistent Hypoglossal Artery and Proatlantal Intersegmental Artery, Case Report and Review

Bilateral persistent primitive hypoglossal arteries associated with unilateral symptomatic carotid occlusion (P1.298)

Bilateral persistent primitive hypoglossal arteries associated with unilateral symptomatic carotid occlusion (P1.298)

Basilar stroke from a persistent hypoglossal artery

Occlusion of the basilar artery can be treated with endovascular thrombectomy, although the results have not been well studied. Persistent fetal cerebrovascular anatomy can lead to unusual presentation of carotid...

Anaesthetic management of a case of giant cerebral aneurysm with persistent hypoglossal artery

AbstractThe persistent hypoglossal artery is a rare carotid basilar anastomosis associated with hypoplastic or absent vertebral arteries. We report a case of clipping of a 2.5 cm size giant aneurysm just distal to the persistent hypoglossal branch, using intra-arterial balloon occlusion and adenosine induced near flow arrest method. It was an anaesthetic challenge to maintain haemodynamic and homeostatic equilibrium throughout the procedure.

A rare case of persistent hypoglossal artery associated with contralateral proximal subclavian stenosis.

The persistent hypoglossal artery is rare vascular anomalies. We report the case of a 50-year old man with right hypoglossal artery, ipsilateral hypoplasic internal carotid artery, associated with left proximal subclavian stenosis with subclavian steal syndrome. Power-Doppler-Ultra-Sonography spectral images obtained after the patient exercised the left arm showed mid-systolic deceleration with retrograde late-systolic velocities. A Computed Tomography Angiography demonstrated a proximal stenosis of the left SA, a mild right ICA hypoplasia and an anomalous artery arising from right ICA at C2–C3 level, entering the cranium via the hypoglossal canal and joining the basilar artery. Usually the presence of PHA may be completely asymptomatic, and detected as an incidental finding by CTA or MRA, but in our case its diagnosis is extremely important because it is often the only vessel supplying blood to the basilar trunk and posterior circulation.

Can Internal Carotid Artery Occlusion Produce Simultaneous Anterior and Posterior Circulation Stroke?

Collateral circulation in the brain is important for maintaining a sufficient cerebral blood flow in case of obstructive disease of arteries. In case of hemodynamic compromise to the anterior circulation, the posterior circulation supplies the anterior circulation via the collaterals. Simultaneous anterior and posterior circulation stroke is a very rare occurrence. It can occur due to cardioembolic stroke or due to anatomical variants of the circle of Willis. Fetal origin of the posterior cerebral artery (PCA) from the internal carotid artery (ICA), persistent trigeminal artery, and persistent hypoglossal artery are known to present with posterior circulation stroke due to occlusive disease of ICA. Here we report a 85-year-old man who presented to us with left hemiparesis. On evaluation, he had right middle cerebral artery (MCA), anterior cerebral artery (ACA), and PCA infarct. Our case most likely had fetal PCA, which can readily explain the PCA infarction in ICA occlusion. Although cases of simultaneous MCA and PCA infarction had been reported in past, we report the first case with simultaneous ACA, MCA, and PCA infarction secondary to fetal PCA.

Persistent hypoglossal artery aneurysm located in the hypoglossal canal with associated subarachnoid hemorrhage

The hypoglossal artery is one of four primitive anastomoses between the internal carotid artery and vertebrobasilar system that regresses in the sixth week of fetal development. A persistent hypoglossal artery (PHA) is generally an incidental finding but may also be associated with aneurysms or arteriovenous malformations. We present a rare case of a PHA with an associated bleeding intracranial PHA aneurysm located in the hypoglossal canal.

Persistence of a hypoglossal artery: case report

The authors present a case of persistent hypoglossal artery. Persistent hypoglossal artery is the second most common carotid-basilar anastomosis with a frequency of 0.02% to 0.09% and it can be associated with cerebrovascular disease. Diagnosis is by imaging methods and angiotomography is the method most often employed.

Tandem symptomatic internal carotid artery and persistent hypoglossal artery stenosis treated by endovascular stenting and flow reversal

Persistence of the hypoglossal artery into adulthood is a rare vascular anomaly and, when present, provides the predominant vascular supply to the posterior circulation. We describe a case of vertebrobasilar...

Double embolic protection during carotid artery stenting with persistent hypoglossal artery

A woman presented with 75% stenosis of the right internal carotid artery (ICA) with extension to the origin of a persistent hypoglossal artery (PHA). The PHA is a rare fetal...