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Persistent Primitive Hypoglossal Artery Associated With Multiple Cerebral Aneurysms.

Rikako Yabuki1, Ei-Ichi Baba1, Kazutaka Shirokane1

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Summary

Persistent primitive hypoglossal artery, a rare vascular variation, can be associated with cerebral aneurysms. This case highlights aneurysms occurring outside the typical posterior circulation, suggesting broader associations.

Keywords:
Anterior communicating arteryCerebral aneurysmMiddle cerebral arteryPersistent primitive hypoglossal arterySubarachnoid hemorrhage

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Area of Science:

  • Neurology
  • Vascular Neurology
  • Neuroimaging

Background:

  • Persistent primitive hypoglossal artery (PPHA) is a rare congenital anastomosis between the internal carotid artery and the vertebrobasilar system.
  • PPHA is occasionally associated with intracranial aneurysms, typically in the posterior circulation.
  • The co-occurrence of PPHA with aneurysms in the anterior circulation is exceptionally rare.

Observation:

  • An 80-year-old female presented with subarachnoid hemorrhage.
  • Angiography revealed aneurysms on the left middle cerebral artery (MCA) and anterior communicating artery (ACoA), as well as a left PPHA.
  • The MCA aneurysm was identified as the source of the hemorrhage.

Findings:

  • The patient underwent successful surgical clipping of both the MCA and ACoA aneurysms.
  • Crucially, neither aneurysm was located on the PPHA itself or within the posterior circulation.
  • This presentation challenges the typical understanding of PPHA-associated aneurysm locations.

Implications:

  • This case suggests that PPHA may be associated with cerebral aneurysms in locations beyond the posterior circulation or directly on the PPHA.
  • Further research is warranted to explore the potential link between PPHA and anterior circulation aneurysms.
  • Clinicians should consider a broader differential diagnosis for aneurysms in patients with PPHA.