Carotid Mycotic Aneurysm associated with Persistent Primitive Hypoglossal Artery. Case Report and Literature Review

Abstract

Carotid mycotic aneurysm is extremely rare and even more unusual when it is associated with a persistent primitive hypoglossal artery. This artery is the second most common of the embryonic carotid-vertebrobasilar anastomoses. It originates from the cervical internal carotid artery and enters the cranium through a widened hypoglossal canal before anastomosing with the basilar artery. We report a case of an elderly man with a rare Salmonella-induced mycotic aneurysm associated with a persistent primitive hypoglossal artery. Surgical resection of the mycotic aneurysm was complicated by a posterior circulation stroke. To the best of our knowledge, there was no previous report of a carotid mycotic aneurysm associated with a persistent primitive hypoglossal artery thus far in the literature. Owing to the high mortality rate of the carotid mycotic aneurysm, it is imperative to be familiar with the vascular and imaging anatomy prior to surgery particularly in the presence of an embryonic carotid-vertebrobasilar anastomosis. In this report, we highlight the imaging characteristics and treatment options for this rare mycotic aneurysm together with a literature review.

Mycotic pseudoaneurysm of the common carotid artery: an unusual neck lump

“…endocarditis. 6 This case is unique as we propose that an asymptomatic ingested fishbone perforated the oesophagus and CCA causing vascular trauma. This acted as a nidus for infection resulting in the mycotic aneurysm.…”

An atypical presentation ofSalmonella entericaser Dublin in an immunocompromised patient

“…Only ~5% of mycotic aneurysms involve the carotid artery. In general, male gender is a risk factor for development of mycotic aneurysm [ 4 ]. Other risk factors include age >50, diabetes, hypertension and atherosclerosis [ 2 , 4 ].…”

“…The standard management of mycotic aneurysms is open surgical repair. There are multiple case reports describing an endovascular approach, but studies comparing endovascular versus open repairs are lacking [ 4 ]. A minimum of 6 weeks of antibiotic therapy is often recommended although there are no data to support a specific duration of treatment [ 6 ].…”