Persistent Hypoglossal Research Articles

Persistent Hypoglossal Artery.

Teaching point: Persistent hypoglossal artery is an extremely rare anatomical variant but has diagnostic and therapeutic relevance.

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

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

Endovascular Treatment of an Aneurysm of a Persistent Primitive Hypoglossal Artery With Complete Resolution of Brainstem Compressive Symptoms: Case Report

Aneurysms of the posterior circulation may manifest with neurological deficits related to mass effect on the brainstem. We present an unusual case of an aneurysm resulting in selective lower-extremity weakness and gait instability. A 61-year-old man presents with progressively worsening gait instability over the course of several months. A magnetic resonance image and computed tomographic angiogram demonstrate a persistent hypoglossal artery associated with an aneurysm invaginating into the pontomedullary junction. The patient manifested only lower-extremity symptoms. An endovascular approach through the right internal carotid artery and persistent primitive hypoglossal artery was assayed, coiling off the aneurysm with complete angiographic occlusion. One month after the procedure, the patient reported marked improvement in symptoms with residual difficulty walking. At the 1-year postprocedure interval, he reported nearly complete resolution of symptoms. Endovascular therapy of an aneurysm invaginating into the brainstem is safe and efficacious.

Posterior Cerebral Artery Territory Infarction Associated with Persistent Primitive Hypoglossal Artery with Internal Carotid Artery Atherosclerosis

Picture 1. (a) T2-weighted brain MRI showing a hyperintense lesion in the right posterior cerebral artery (PCA) territory. Difusion-weighted brain MRI showing no hyperintense lesions (figure not shown). (b, c) Brain MR angiography demonstrating right persistent primitive persistent hypoglossal artery (PPHA) originating from the right internal carotid artery (ICA) to the basilar artery. Bilateral vertebral arteries appeared hypoplastic and almost al the blood flow to the basilar artery was supplied by PPHA. (d) Carotid ultrasonography demonstrating iso-echoic plaque of 2 mm at the origin of the right ICA (white arrow). □ PICTURES IN CLINICAL MEDICINE □

A Case of Aneurysm on a Persistent Hypoglossal Artery Treated by Endovascular Coiling

We describe a 22-year-old woman admitted to hospital in emergency with nuchal headache and vomiting. CT scan disclosed subarachnoid hemorrhage. Digital subtraction angiography with three-dimensional rotational acquisitions showed a ruptured aneurysm of a right persistent primitive hypoglossal artery as the cause of symptoms and hemorrhage. The patient was successfully treated with endovascular coiling of the aneurysm. This is the second literature report describing endovascular treatment in this unusual condition.

Persistent hypoglossal artery

It is well known that the internal carotid artery has no branches in the neck during postfetal life (von Lanz & Wachsmuth, 1955), but during embryonic development there are anastomotic connections between the internal carotid and basilar artery that rarely persist after intrauterine life (Hassen‐Khodja et al. 1992; Widmann & Sumpio, 1992; De Caro et al. 1995). The most common anomaly found incidentally on angiography is a persisting trigeminal artery, but persistent hypoglossal, otic and proatlantal arteries can also be found (Reynolds et al. 1980; Ouriel et al. 1988; Salas et al. 1998). We report a rare example of a persistent hypoglossal artery in a 64 y old female cadaver, cause of death unknown, embalmed by standard mortuary procedures for dissection during the routine anatomy course. The persistent hypoglossal artery originated from the anteromedial wall of the left internal carotid artery 2.5 cm above the bifurcation (Fig.). It extended towards the hypoglossal canal. The diameter of its lumen was 1.5 mm. During its course in the neck, it was positioned anterior to the internal carotid artery and medial to the facial and lingual arteries, the posterior belly of the digastric muscle and the convexity of the hypoglossal nerve in the neck. At 1 cm above the convexity of the hypoglossal nerve in the neck, the artery gave rise to a branch that entered the skull through the carotid canal anteromedial to the internal carotid artery (Fig. 1) and joined the basilar artery. The medial branch of the hypoglossal artery crossed the internal carotid artery on its medial side and entered the skull together with the hypoglossal nerve and joined the basilar artery. We found no other anomalies in the cerebral arterial system.

SUBARACHNOID HAEMORRHAGE DUE TO RUPTURE OF AN ANEURYSM ON A PERSISTENT LEFT HYPOGLOSSAL ARTERY.

The presence of persistent carotid-basilar anastomosis is well known. From autopsy studies such communications along the first division of the 5th nerve (trigeminal artery) and along the auditory and hypoglossal nerves (persistent auditory and hypoglossal arteries) have been described. Since the first demonstration by Sutton (1950) a large number of cases of the trigeminal variation of these persistent arterial channels demonstrated by angiography have been published (Krayenbuhl, 1957). There have been 11 cases in the arteriographic records of the Johns Hopkins Hospital since 1949. However, only five cases have been reported in the literature of a persistent hypoglossal artery (Morris and Moffat, 1956), and only one case was demonstrated by carotid arteriography (Begg, 1961).* There is no reference to an aneurysm arising from the persistent hypoglossal artery. D.N., JHH 1034675, a 26-year-old stoker, was seen in the emergency room of the Johns Hopkins Hospital because of sudden onset of severe occipital h...