Persistent Primitive Hypoglossal Artery and Its Association with Stroke

A persistent primitive hypoglossal artery (PPHA) is often discovered during carotid angiography incidentally or secondary to internal carotid artery (ICA) stenosis.[1] T1-weighted imaging of fat suppression can reveal findings like the real lumen, false lumen, and intramural hemorrhage at the dissection site.[2]

Herein, we report a case by magnetic resonance (MR) angiography of a PPHA in a 37-year-old male who presented with ischemic stroke due to thrombosis at the bifurcation of the carotid and the hypoglossal artery. Clinically, he presented with giddiness and left-sided limb weakness for a day followed by slurring of speech. He was a known hypertensive. On admission, he had right-sided hemiparesis, difficulty in breathing, and chorea. Diffusion-weighted MR imaging ([Fig. 1]) revealed acute nonhemorrhagic infarcts involving the right corona radiata, right cerebral hemisphere, bilateral thalami, right paramedian pons, bilateral cerebellar hemisphere, and cerebellar vermis in the right middle cerebral artery, bilateral posterior cerebral artery, and cerebellar arterial territories ([Fig. 1A], showing infarct in the bilateral thalami and left cerebral hemisphere). The right hypoglossal artery is seen arising from the cervical part of the right ICA at the C2 level. A small filling defect measuring about 13 × 5.6 mm is noted at the bifurcation of the right ICA and right hypoglossal artery, suggesting a thrombus. The right hypoglossal artery is seen continuing as a basilar artery ([Fig. 1B, C]). Focal fenestration of the basilar artery is noted at its origin. Maximum intensity projection three-dimensional time-of-flight MR neck and head angiography images are seen depicting the same ([Fig. 1D–F]). The rest of the intracranial vasculature was otherwise normal. The patient was symptomatically treated, and his neurological condition remained stable during the follow-up.

Fig. 1 (A) Areas of diffusion restriction appearing bright on trace with corresponding low apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI) seen involving the bilateral thalami and left cerebral hemisphere. The right hypoglossal artery (blue arrow) is seen continuing as a basilar artery (B). A small filling defect (yellow arrow) is seen at the bifurcation of the right internal carotid artery and right hypoglossal artery, suggesting a thrombus (C). Maximum intensity projection (MIP) coronal and coronal oblique images of three-dimensional (3D) time-of-flight (TOF) magnetic resonance (MR) neck angiography (D, E) showing anomalous artery (right hypoglossal artery - red arrow) inferiorly anastomosing with/arising from the cervical part of the right carotid internal artery at the C2 level. MIP coronal images of 3D TOF MR of circle of Willis angiography (F) depicting the cranial part of the right hypoglossal artery (red arrow) seen continuing as basilar artery.

Conflict of Interest

None declared.

• References

• 1 Wan Z, Liu T, Xu N, Liu Q, Yu X, Wang H. Concurrence of multiple aneurysms, extreme coiling of the extracranial internal carotid artery and ipsilateral persistent primitive hypoglossal artery: a case report and literature review. Front Neurol 2022; 13: 1053704
• 2 Han J, Ji Y, Ma G, Kang Z. Recurrent cerebral infarction in anterior and posterior circulation territories associated with persistent primitive hypoglossal artery and carotid artery dissection: a case report. Int J Neurosci 2018; 128 (10) 1003-1005

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Artikel online veröffentlicht:
21. Mai 2025