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Persistent Primitive Hypoglossal Artery in a 55-Year-Old Woman with Recurrent Dizziness, Identified on Ultrasound and Computed Tomography Imaging

  • 0Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
The American Journal of Case Reports +

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November 28, 2025

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November 28, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Persistent primitive hypoglossal artery (PPHA) is a rare vascular anomaly where an artery bypasses the usual vertebral artery. Diagnosis involves ultrasound and CT angiography, aiding awareness and management.

Area Of Science

  • Neurology
  • Vascular Biology
  • Medical Imaging

Background

  • Persistent primitive hypoglossal artery (PPHA) is a rare congenital vascular remnant.
  • It typically arises from the internal carotid artery (ICA) and connects to the vertebrobasilar system via the hypoglossal canal.
  • This anomaly bypasses the normal vertebral artery (VA) supply to the basilar artery (BA).

Purpose Of The Study

  • To describe a case of PPHA presenting with dizziness in a 55-year-old woman.
  • To highlight the diagnostic approach using ultrasound (US) and computed tomography (CT) angiography (CTA).
  • To raise awareness of this rare congenital vascular anomaly.

Main Methods

  • Carotid Doppler ultrasound (CDU) to assess internal carotid artery (ICA) and vertebral arteries (VAs).
  • Transcranial color-coded sonography (TCCS) to evaluate intracranial flow and posterior cerebral arteries (PCAs).
  • Computed tomography (CT) angiography (CTA) for definitive confirmation of PPHA anatomy.

Main Results

  • Ultrasound revealed a dilated left ICA with an anomalous branch and hypoplastic bilateral VAs.
  • TCCS showed absent intracranial VA flow and reduced bilateral PCAs peak systolic velocity (PSV) during left common carotid artery (CCA) compression.
  • CTA confirmed left-sided PPHA originating from the ICA at C1-C2, passing through the hypoglossal canal to the BA, with absent posterior communicating arteries.

Conclusions

  • PPHA is a rare congenital vascular anomaly.
  • A combination of US and CT angiography is effective for diagnosing PPHA.
  • Increased awareness of PPHA is important for diagnosis and management.

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