Persistent hypoglossal arteries with aneurysmal dilation of left hypoglossal artery: a rare case report and review of the literature

Abstract

Persistence of foetal anastomoses between carotid and vertebrobasilar arteries is a well-known anomaly, although bilateral persistence of these anastomoses is uncommon. Persistent hypoglossal artery is one of the four anastomotic vessels between the carotid and the vertebrobasilar arterial systems. Persistence of bilateral hypoglossal arteries with other associated anomalies is exceptionally uncommon and may result in unusual symptoms or have implications for therapy. We report an incidentally detected case of bilateral persistent hypoglossal arteries with an associated finding of hypoplastic vertebral arteries, describe their embryology and consider the potential clinical implications of this finding.

Bilateral persistent primitive hypoglossal artery presenting with hemiplegia✰

“…These are frequently associated with the hypoplasia of the vertebrobasilar system. The presence of bilateral persistent HAs is very rare with just 6 cases reported in the literature till date [2] , [5] , [6] , [7] , [8] , [9] . Relevant findings of these cases from the literature and our case are described in Table 1 .…”

“… Serial no. Author Age/sex Vertebral arteries Complication Case 1 Murayama et al [5] 59/M Hypoplastic Ruptured aneurysm located at the junction of left hypoglossal artery and basilar artery Case 2 Takahashi et al [2] 76/F Absent None Case 3 Karasawa et al [6] 39/M Absent on left side Hypoplastic on right Subarachnoid hemorrhage (cause was unknown even after autopsy) Case 4 Oonishi [7] - - - Case 5 Garge et al [8] 60/F Both mildly hypoplastic Subarachnoid hemorrhage with fusiform aneurysmal dilation of the left hypoglossal arteries toward its basilar segment Case 6 Patira et al [9] 79/M Absent Subocclusive thrombus in right cervical internal carotid arteries just distal to the hypoglossal arteries with infarct in right Middle Cerebral Artery (MCA) distribution Case 7 (Our case) 20/F Bilateral hypoplastic None …”

“…Rarely aneurysms can develop at the junction of basilar artery [5] , [8] , [12] . However, the incidence of vascular anomalies associated with the persistent trigeminal artery is up to 25% [4] , [13] , [14] .…”

Posterior fossa transient ischemic attack in the setting of bilateral persistent hypoglossal arteries

“…The following data were extracted from relevant reports: author, publication year, age (year), sex, dominant PHA, vertebral arteries, imaging modalities, complication. Data were summarized in Table 1 [7–13] . Because the number of cases is too small, it is impossible to meta-analyze the data.…”

“…It is often accompanied by hypoplasia of VA and circle of Willis, so it is closely related to posterior circulation stroke [6] . Only 7 cases of bilateral PHAs have been reported [7–13] . We presented a case of bilateral PHAs which is characterized by posterior fossa TIA with dizziness as the main symptom.…”