Cerebral Infarction in Both Carotid and Vertebrobasilar Territories Associated with a Persistent Primitive Hypoglossal Artery with Severe Dilated Cardiomyopathy

Kawano, Hiroyuki; Inatomi, Yuichiro; Hirano, Teruyuki; Yonehara, Toshiro

doi:10.1016/j.jstrokecerebrovasdis.2012.07.020

Cited by 11 publications

(6 citation statements)

References 6 publications

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“…Previous studies ( 11 – 13 ) on BAO accompanied by PHA have mostly attributed it to cardioembolic stroke, and aspiration alone has a high rate of recanalization ( Table 1 ). In this case, the mechanism of BAO was considered to be ischemic stroke based on intracranial atherosclerotic stenosis (ICAS), which is highly prevalent in East Asian populations.…”

Section: Discussionmentioning

confidence: 99%

Case report: Mechanical thrombectomy for acute basilar artery occlusion via persistent hypoglossal artery

et al. 2023

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Persistent hypoglossal artery (PHA) is a rare carotid-vertebrobasilar anastomosis in adults. Here, we report a case of mechanical thrombectomy for acute basilar artery occlusion via the PHA. A 44-year-old man was admitted to our stroke unit with an unstable gait and aphasia for 2 h. The baseline National Institutes of Health Stroke Scale (NIHSS) score was 4, but the clinical symptoms continued to worsen. Computed tomography angiography showed the absence of the basilar artery and an abnormal anastomosis between the anterior and posterior circulation. Clinical symptoms continued to worsen, and endovascular treatment was scheduled. PHA was demonstrated and basilar artery occlusion was confirmed using digital subtraction angiography. Mechanical thrombectomy with a stent retriever and aspiration was performed via the PHA, and modified thrombolysis in cerebral infarction level 3 was achieved. The patient underwent intravenous antiplatelet therapy after the operation, and follow-up neuroimaging revealed multiple small infarcts in the cerebellum and medulla oblongata. The patient was discharged after 10 days for further rehabilitation, with an NIHSS score of 25. At 10 months follow-up, the NIHSS score decreased to 18. Recognition of this rare variation is particularly important for interventional strategy determination and rapid recanalization of basilar artery occlusion.

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Section: Discussionmentioning

confidence: 99%

Case report: Mechanical thrombectomy for acute basilar artery occlusion via persistent hypoglossal artery

et al. 2023

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“…The PPHA is usually a benign, incidental finding on radiological imaging obtained for other clinical indications. When symptomatic, PPHAs have been associated with TIA, vertebrobasilar headache syndrome, a bowhunter-like dynamic syncopal syndrome, glossopharyngeal neuralgia, aneurysmal subarachnoid hemorrhage, and atheroembolic cerebrovascular accident [ 1 - 3 , 5 , 12 , 15 , 18 - 20 ]. Its identification is essential in the setting of symptomatic carotid atherosclerotic disease and must be taken into consideration when planning carotid procedures such as endarterectomy or stenting.…”

Section: Discussionmentioning

confidence: 99%

Transient Ischemic Attack in the Setting of Carotid Atheromatous Disease with a Persistent Primitive Hypoglossal Artery Successfully Treated with Stenting: A Case Report

Huang¹,

Moisi²,

Zwillman

et al. 2016

Cureus

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Fetal brain perfusion is supplied by the primitive dorsal aorta anteriorly, longitudinal neural arteries posteriorly, and anastomotic transverse segmentals. Most notable of these connections are the primitive trigeminal, otic, hypoglossal, and proatlantal arteries. With cranial-cervical circulatory maturation and development of the posterior communicating segments and vertebro-basilar system, these primitive segmental anastomoses normally regress. Anomalous neurovascular development can result in persistence of these anastomoses. Due to its territory of perfusion, the persistent primitive hypoglossal artery (PPHA) is associated with vertebral artery and posterior communicating artery hypoplasia or aplasia. As a consequence, primary blood supply to the hindbrain comes chiefly from this single artery. Although usually clinically silent, PPHA is susceptible to common cerebrovascular disorders including athero-ischemic disease and saccular aneurysmal dilation to name a few. We present a case of transient ischemic attack in a patient with a PPHA and proximal atherosclerotic disease treated by endovascular stenting.

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“…1 In the literature, associations between cerebral infarction of carotid and vertebrobasilar territories and PPHA are described. [10][11][12] The PPHA may serve as a pathway for an embolus originating from an atherosclerotic disease of the internal carotid artery to reach the posterior circulation. 11 Temporary clamping of the PPHA during carotid endarterectomy may increase the risk of ischemia.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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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.

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Cerebral Infarction in Both Carotid and Vertebrobasilar Territories Associated with a Persistent Primitive Hypoglossal Artery with Severe Dilated Cardiomyopathy

Cited by 11 publications

References 6 publications

Case report: Mechanical thrombectomy for acute basilar artery occlusion via persistent hypoglossal artery

Case report: Mechanical thrombectomy for acute basilar artery occlusion via persistent hypoglossal artery

Transient Ischemic Attack in the Setting of Carotid Atheromatous Disease with a Persistent Primitive Hypoglossal Artery Successfully Treated with Stenting: A Case Report

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

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