Download PDF
Int J Angiol 2017; 26(02): 121-124
DOI: 10.1055/s-0035-1568879
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Variation of a Persistent Primitive Hypoglossal Artery (PPHA) as Incidental Finding in the Diagnostic Clarification of Cerebral Vasculopathy Associated with Intracranial Vasculitis

S. Hopf-Jensen
1   Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Flensburg, Germany
,
L. Marques
1   Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Flensburg, Germany
,
M. Preiß
1   Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Flensburg, Germany
,
W. Börm
2   Department of Neurosurgery, Diakonissenhospital, Flensburg, Germany
,
S. Müller-Hülsbeck
1   Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Flensburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
08 December 2015 (online)

    Permissions and Reprints

Abstract

We present a very rare variation of a persistent primitive hypoglossal artery (PPHA) arising from the internal carotid artery, detected during a diagnostic angiography. A 50-year-old female patient was admitted with an atypical intracranial hematoma in the left frontal lobe. Catheter angiography revealed intracranial vasculopathy with segmental stenoses, a small aneurysm of the right internal carotid artery bifurcation and a “string of beads” appearance of the left carotid artery, consistent with fibromuscular disease. On the left side, a vertebral artery ending in the posterior inferior cerebellar artery (PICA) was detected, whereas on the right side the vertebral artery was aplastic. During selective angiography of the right common carotid artery, a persistent hypoglossal artery was seen supplying the basilar artery. The literature of persistent embryonal carotid-vertebrobasilar anastomosis and their anatomical variations is discussed with respect to clinical importance for ischemia, interventional procedures, and surgery.

Keywords

aneurysm - artery - vasculitis - vascular access - symptomatic - internal carotid artery
 

  • References

  • 1 Clerici AM, Craparo G, Cafasso G, Micieli C, Bono G. De-novo headache with transient vertebro-basilar symptoms: role of embryonic hypoglossal artery. J Headache Pain 2011; 12 (6) 639-643
    CrossrefPubMedGoogle Scholar
  • 2 He S, Russin JJ, Adamczyk P, Giannotta SL, Amar AP, Mack WJ. A Persistent Primitive Hypoglossal Artery Arising from the External Carotid Artery Associated with Subarachnoid Hemorrhage. World Neurosurg 2014; 82 (1–2): 239.e1-3
    CrossrefPubMedGoogle Scholar
  • 3 Nanto M, Takado M, Ohbuchi H , et al. Rare variant of persistent primitive hypoglossal artery, arising from the external carotid artery. Neurol Med Chir (Tokyo) 2012; 52 (7) 513-515
    CrossrefPubMedGoogle Scholar
  • 4 Pavlisa G, Rados M, Ozretic D, Pavlisa G. Endovascular treatment of AVM-associated aneurysm of anterior inferior cerebellar artery through persistent primitive hypoglossal artery. Br J Neurosurg 2012; 26 (1) 86-88 10.3109/02688697.2011.584983
    CrossrefPubMedGoogle Scholar
  • 5 Lemke A-J, Götz Benndorf G, Liebig T, Felix R. Case Report, Anomalous Origin of the Right Vertebral Artery. Review of the Literature and Case Report of Right Vertebral Artery Origin Distal to the Left Subclavian Artery AJNR Am J Neuroradiol 1999; 20: 1318-1321
    PubMedGoogle Scholar
  • 6 Gluncic V, Ivkic G, Marin D, Percac S. Anomalous origin of both vertebral arteries. Clin Anat 1999; 12 (4) 281-284
    CrossrefPubMedGoogle Scholar
  • 7 Fazan VP, Caetano AG, Filho OA. Anomalous origin and cervical course of the vertebral artery in the presence of a retroesophageal right subclavian artery. Clin Anat 2004; 17 (4) 354-357
    CrossrefPubMedGoogle Scholar
  • 8 Higashi N, Shimada H, Simamura E, Hatta T. Right vertebral artery as the fourth branch of the aortic arch. Anat Sci Int 2008; 83 (4) 314-318
    CrossrefPubMedGoogle Scholar
  • 9 Osborn A. Diagnostic Cerebral Angiography. 2nd ed. Lippincott Wiliams & Wilkins; 1999
    Google Scholar
  • 10 Uzawa A, Aotsuka A, Terano T. Posterior cerebral artery territory infarction associated with persistent primitive hypoglossal artery with internal carotid artery atherosclerosis. Intern Med 2010; 49 (5) 515-516
    CrossrefPubMedGoogle Scholar
  • 11 Silva CE, Romero AdelC, Freitas PE , et al. Persistent primitive hypoglossal artery associated with brain stem ischemia in a young patient. Arq Neuropsiquiatr 2013; 71 (3) 194-195
    CrossrefPubMedGoogle Scholar
  • 12 Kawano H, Inatomi Y, Hirano T, Yonehara T. Cerebral Infarction in both Carotid and Vertebrobasilar Territories Associated with a Persistent Primitive Hypoglossal Artery with Severe Dilated Cardiomyopathy. J Stroke Cerebrovasc Dis 2013; 23 (1) 176-178
    PubMedGoogle Scholar
  • 13 Yuasa H, Mitake S, Oguri T, Miura T, Torii T, Kato D. A case of transient blindness due to severe stenosis of the internal carotid artery with persistent primitive hypoglossal artery (PPHA) [in Japanese]. Rinsho Shinkeigaku 2005; 45 (8) 579-582
    PubMedGoogle Scholar
  • 14 Hui FK, Schuette AJ, Cawley CM. Endovascular treatment of an aneurysm of a persistent primitive hypoglossal artery with complete resolution of brainstem compressive symptoms: case report. Neurosurgery 2011; 68 (3) E854-E857 , discussion E857
    CrossrefPubMedGoogle Scholar
  • 15 De Blasi R, Medicamento N, Chiumarullo L , et al. A case of aneurysm on a persistent hypoglossal artery treated by endovascular coiling. Interv Neuroradiol 2009; 15 (2) 175-178
    CrossrefPubMedGoogle Scholar
  • 16 Powers WJ. Primary angiitis of the central nervous system: diagnostic criteria. Neurol Clin 2015; 33 (2) 515-526
    CrossrefPubMedGoogle Scholar