Persistent hypoglossal artery and persistent trigeminal artery presenting with posterior fossa transient ischemic attacks

Abstract

Two patients, one with a persistent hypoglossal artery and the other with a persistent trigeminal artery, presented with transient ischemic attacks in the distribution of the posterior fossa. Both had stenosis and ulcerative plaques at the carotid bifurcation. Their symptoms were successfully relieved after carotid endarterectomy.

The Persistent Trigeminal Artery and Its Topographical Relations

“…The discussion about the blood streams in cases of this variety explained by Fiebach and Agnoii 11973] has not yet come to a conclusion. Hence the possi bility of a resulting permanent diminution of blood supply assumed by Lahl et al [1982] or of transient ischemic attacks related by Stern et al [ 1978] needs further clinical research.…”

Persistent primitive hypoglossal artery associated with brain stem ischemia in a young patient

“…other carotid-basilar anastomoses and bone malformation at the craniocervical junction 1,4,5 . The PPHA may serve as a pathway for an embolus from the ICA to reach the posterior circulation.…”

“…The PPHA may serve as a pathway for an embolus from the ICA to reach the posterior circulation. Since the PPHA represents a complementary and compensatory artery for the vertebrobasilar system, an embolus from the ICA could reach the posterior circulation 1,4,5 . In patients with both carotid atherosclerosis and cerebrovascular disease in the vertebrobasilar territory, PPHA should not be ignored.…”

“…In patients with both carotid atherosclerosis and cerebrovascular disease in the vertebrobasilar territory, PPHA should not be ignored. Blood flow dynamics and the vascular anatomy play an important role in the origin and development of atherosclerosis 4 . Any surgical approach should be performed with utmost care in order to maintain adequate cerebral perfusion in spite of ICA clamping, as the PPHA may provide most of the blood flow to the posterior circulation 2,3 .…”

Persistent Trigeminal Artery and Brain Stem Stroke

“…PTAs may be more frequent in the presence of mental subnormality [17], Recent publication highlight the hazards of transphcnoidal pituitary surgery in the presence of an intrasellar PTA [18]. and the importance of recognising PTAs before performing procedures involving intracra nial arterial embolisation [ 19], Of greater relevance to the ease described above, several reports have described the occurrence of transient brain stem ischaemia as a result of spontaneous embolism from ulcerated atheromatous plaques in the internal carotid artery through a PTA into the vertebro-basilar circulation [6,[20][21][22], Carotid endarterectomy success fully aborted the ischaemic attacks in all these cases. In one further case severe atheroma in the carotid circulation as well as in the per sistent trigeminal artery itself was associated with multifocal infarc tion in the basilar artery' territory [23], Unilateral internuclear ophthalomoplcgia has been described immediately following carotid angiography in a young woman with a PTA in whom no other risk factors were apparent [24], The internuclear ophthalmoplegia re solved over the following 9 days.…”