We report a case of a left sided primitive hypoglossal artery detected by. Persistent hypoglossal artery with hypoplasia of the. The internal carotid occasionally provides an aberrant vessel in the cavernous sinus, which passes posteriorly to anastomose with the basilar artery. Facial reanimation by means of the hypoglossal nerve. Persistent bilateral hypoglossal arteries has entering the skull through. This anastomotic vessel arose from the external carotid artery eca, not internal carotid artery, and entered the hypoglossal canal to basilar artery. Primitive hypoglossal artery the persistent hypoglossal artery is the second most common carotidvertebrobasilar artery anastomosis, with a prevalence of 0. After passing through an enlarged hypoglossal canal, it joins the basilar artery inferiorly. They are named, with the exception of the proatlantal artery, using the cranial nerves with which they run persistent trigeminal artery. Persistent primitive hypoglossal artery, ct angiography, anatomic variant. In one case of a rudimentary vertebral artery that stopped short of the skull, the basilar arose as a branch of the internal carotid in the neck and entered the cranial cavity through the hypoglossal canal. A 71yearold female had vertigo attacks once or twice a day secondary to vertebrobasilar insufficiency. Studies of postpartum mammary gland involution reveal novel prometastatic. Persistent hypoglossal artery complicated by internal carotid.
Abstract the hypoglossal artery is rarely described member of carotidbasilar family anastomoses. The pha is a rare fetal variant of carotidbasilar anastomosis that elevates the risk of ischemia and embolic infarction within the posterior cerebral circulation in patients with carotid disease proximal to the anastomosis. Persistent primitive hypoglossal artery associated with lower. Oct 31, 20 primitive hypoglossal artery the persistent hypoglossal artery is the second most common carotidvertebrobasilar artery anastomosis, with a prevalence of 0. Bilateral persistent primitive hypoglossal artery presenting with. Persistent hypoglossal artery and its variants diagnosed by. However, unusual and extremely rare variants of pha have been reported, such as those arising from the external carotid artery eca 7 or. Persistent primitive trigeminal artery radiology reference article. The vertebral artery on the contralateral side ended as a posterior inferior cerebellar artery.
Morphological characteristics of 108 cases of uni and bilateral aplasia of the vertebral artery va in reports or images of retrospective studies, including one recent case, published between 1967 and 2016 are analyzed. The persistent hypoglossal artery is the second most common carotidvertebrobasilar anomalous anastomosis the first being the trigeminal artery 1. We describe a unique case of a female infant patient with. Associated with persistent primitive hypoglossal artery. We evaluated the prevalence of pha on computed tomography ct angiography. Intracranial arteries variants radiology reference. The largesized pha originating from the cervical internal carotid artery passed through the hypoglossal canal together with the hypoglossal nerve and reached the posterior cranial fossa to anastomose the basilar artery. The involution of the trigeminal artery during embryonic development is. The trigeminal artery is an artery that supplies the basilar artery with blood during human. We also evaluated characteristic features of pha and its variants on magnetic resonance mr angiography. Miller a unique variant of a right persistent hypoglossal. The trigeminal artery is the most common of the four persistent fetal.
This would standardize the hypoglossalfacial nerve transfer and its variants, allowing for an easier performance of these procedures. Diagnosis and clinical implications sunil v furtado 1, kalyan reddy 2, nilesh khandelwal 2, as hegde 1. Their clinical significance may be variable but knowledge and recognition of these variants is fundamental, especially if surgical or endovascular treatments e. Raynauds disease a disorder that causes the blood vessels to narrow when you are cold or feeling stressed. The posterior circulation of the circle of willis forms when the fetal posterior cerebral artery pca becomes the pcom, the adult pca connects with the basilar artery ba, and the posterior choroidal artery incorporates into the ba. Tic douloureux caused by primitive trigeminal artery or its variant in. Apr 16, 2020 the hypoglossal nerve descends vertically through the retrostyloid space. Jul 23, 2003 the primitive hypoglossal artery pha is a rare vascular anomaly, which belongs to the group of carotidbasilar anastomosis that may occur in adults.
The vessel courses through the hypoglossal canal to form the basilar artery green arrow. The presence of a persistent carotidbasilar com munication and the suspicion that a greater than. It is second in frequency to the trigeminal artery which is present approximately six times as often it arises from the distal cervical ica, usually between c1 and c3. Hypoglossal nerve disorders msd manual consumer version. Persistent primitive hypoglossal artery ppha is a rare embryonic carotid vertebrobasilar artery anastomosis. The posterior inferior cerebellar artery arising from the. Persistent primitive hypoglossal artery associated with. Jan 01, 2016 persistent primitive hypoglossal artery ppha is a rare embryonic carotid vertebrobasilar artery anastomosis. To our knowledge, this is the fourth reported case of.
Angiographic findings and clinical implications of persistent. In utero the trigeminal artery supplies the basilar artery be. The artery arises from the internal carotid artery in the base of the neck, enters the cranial cavity through the anterior condylar canal and terminates by becoming the basilar artery. Persistent hypoglossal artery is the second most common carotidbasilar anastomosis with a frequency of 0. After formation of the posterior communicating artery, which develop between the distal.
The significance of persistent trigeminal artery radiology. Hypoglossal artery arises from the internal carotid artery ica between the c1 and c2 vertebral levels and traverses through the hypoglossal canal to join the vertebrobasilar system. The vertebral arteries va are paired arteries, each arising from the respective subclavian artery and ascending in the neck to supply the posterior fossa and occipital lobes, as well as provide segmental vertebral and spinal column blood supply. A case of symptomatic cervical carotid artery stenosis with persistent primitive hypoglossal artery ppha. Persistent hypoglossal artery pha, a rare embryological carotidbasilar. It is second in frequency to the trigeminal artery which is present approximately six times as often. The trigeminal artery is an artery that supplies the basilar artery with blood during human embryonic development. The aneurysm was successfully treated using a novel lowprofile visualized intraluminal support. The primitive hypoglossal artery pha is a rare vascular anomaly, which belongs to the group of carotidbasilar anastomosis that may occur in adults. Incidence, gender, persistence of carotidvertebrobasilar anastomosis cvba, associated with other vascular variants, and vascular pathology in each group of uni and.
Bapuraj jr, ojili v, khandelwal n, shanbhogue ak, gupta sk. The persistent carotidvertebrobasilar anastomoses are variant anatomical arterial communications between the anterior and posterior circulations due to abnormal embryological development of the vertebrobasilar system. Our focus in this study is on the anatomic and surgical relationships of the facial and hypoglossal nerves given their relevance to determine the exposure length required in each technical variant. Left carotid angiography revealed persistent primitive hypoglossal artery ppha associated with a large internal carotid artery ica aneurysm and severe stenosis of the ica.
The authors present a rare case of a persistent primitive hypoglossal artery pha variant ending in the posterior inferior cerebellar artery pica without an interposed segment of the basilar artery and describe briefly the possible embryogenesis of this anomaly. Double embolic protection during carotid artery stenting. In addition, the ipsilateral vertebral artery and bilateral posterior communicating arteries were hypoplastic. Isolated stenosis of a persistent hypoglossal artery visualized at 3d ct angiography. Unrecognised normal variants may be misinterpreted as possible pathology causing unnecessary clinical concern and costly investigation. Photograph of the cadaveric specimen showing the persistent primitive hypoglossal artery ha emerging from the hypoglossal canal hc. Hypoglossal canal definition of hypoglossal canal by. Persistent carotidvertebrobasilar anastomoses radiology. A biopsy ofthe hypoglossal nerveinthat casewasnotdone. Persistent hypoglossal artery as a potential risk factor.
For this reason, an indicative list of normal variants has been. A unique variant of a right persistent hypoglossal artery arising from the common carotid artery with complex cardiovascular anomalies in a female neonatal patient. Additionally, the diagnostic alternatives for detection and assessment of pha and the spectrum of. The hypoglossal nerve holds this relation until it. This may be better achieved by ct andor mri than by conventional angiography. The persistent hypoglossal artery originates from the internal carotid artery at the levels of the c1 through c3 vertebral bodies, courses through the hypoglossal canal.
Pha is defined as persistent primitive hypoglossal artery rarely. Persistent primitive hypoglossal artery ppha, a remnant of embryonal circulation, is a rare variant of the posterior cerebral circulation. This all forms the anterior circulation of the circle of willis. Definition best practice necessitates particular emphasis on situations which may compromise patient care. Persistent primitive hypoglossal artery, carotidvertebrobasilar anastomosis, rare vascular anatomical variant, cardiovascular. Apr 14, 2010 we present an extremely rare case of a variant of persistent primitive hypoglossal artery, which was found incidentally in magnetic resonance angiography during an examination for dizziness. Seven prior cases of posterior circulation stroke in the setting of ppha have been described in the literature, with all but one case being attributable to atherosclerotic embolization from the internal carotid artery ica through the ppha. Persistent hypoglossal artery in 61yearold woman examined for.
A unique variant of a right persistent hypoglossal artery arising from. The persistent primitive hypoglossal artery is a carotidvertebrobasilar anastomosis, which commonly arises from the internal carotid artery at the level of the c vertebrae, enters the skull base through the hypoglossal canal and supplies the basilar artery. A case of aneurysm on a persistent hypoglossal artery treated. Persistent primitive trigeminal artery ppta is one of the persistent. Together with a caudal end of the primitive internal artery, trigeminal, otic, and proatlantal. Anatomical features and clinical relevance of a persistent. A 63yearold man presented with an extremely rare variant of persistent primitive hypoglossal artery pha, which was found incidentally during examination for a contralateral asymptomatic. We present an extremely rare case of a variant of persistent primitive hypoglossal artery, which was found incidentally in magnetic resonance angiography during an examination for dizziness.
Therefore it appears that a persistent hypoglossal artery may produce increased flow ve locities in the ica, simulating ica stenosis. It is second in frequency to the trigeminal artery which is present approximately six. The first to do so is the otic artery, sequentially followed by the hypoglossal, trigeminal and the proatlantal intersegmental artery. Coronary artery disease and carotid artery disease, diseases that involve the narrowing or blockage of an artery. Persistent primitive hypoglossal artery associated with lower basilar artery aneurysm. Basilar artery aneurysm treated with coil embolization via persistent primitive hypoglossal artery. The authors present a case of persistent hypoglossal artery. Anatomy, head and neck, lingual artery statpearls ncbi. The persistent trigeminal artery pta was first reported at autopsy by richard quain in 1844 and via angiography by sutton in 1950. Pha stands for persistent primitive hypoglossal artery. Expanding upon the core of the highly popular second edition, this updated reference is fully revised to provide the best spinerelated diagnostic support available. Persistent hypoglossal artery is the second most common. However, in some cases, the artery persists into adulthood and can cause medical complications, including intracranial aneurysms.
Normally, the trigeminal artery involutes after the formation of the posterior communicating artery. Knowledge of this rare but important variant can have significant implications for medical management and surgical. Stroke a serious condition that happens when blood flow to your brain stops. A persistent primitive hypoglossal artery ppha is a rare vascular anomaly, which belongs to the group of carotidbasilar anas tomosis that may occur in adults. Diagnosis is by imaging methods and angiotomography is the method most often employed. When intracanalicular enlargement of the hypoglossal canal is identified, this anomalous vessel should be the primary consideration in the differential diagnosis. Jul 22, 2012 persistent hypoglossal artery pha is the second most common anastomosis between the carotid and vertebrobasilar systems and demonstrates some variations. The ascending pharyngeal artery is an artery in the neck that supplies the pharynx, developing from the proximal part of the embryonic second aortic arch it is the smallest branch of the external carotid and is a long, slender vessel, deeply seated in the neck, beneath the other branches of the external carotid and under the stylopharyngeus muscle. It originates from the extracranial internal carotid artery as a large collateral branch, ascends vertically, passes through the hypoglossal canal and continues as the basilar trunk. An mra shows a persistent hypoglossal artery blue arrow originating from the cervical left internal carotid artery.
Persistent hypoglossal artery is the second most common carotidbasilar. Definitive diagnosis of this anatomic variant is accomplished using imaging exams. Norihiko fujita, nobumitsu shimada, hiroshi takimoto, and. The canals ofthepresentcasesand that ofconstans etal. A rare case of persistent hypoglossal artery associated with. Unilateral aplasia versus bilateral aplasia of the vertebral. Feb 20, 2018 the key finding to distinguish the persistent hypoglossal artery from the proatlantal artery that has nearly the same orientation is the identification of the foramen through which the artery passes.
Carotid artery stenting for symptomatic stenosis of the. This artery is a rare remnant of the embryonic circulatory system that unites the proximal intracavernous segment of internal carotid artery ica with the middle or distal portion of the basilar artery ba. In one case, the internal carotid gave rise to a vertebral artery that entered the cranial cavity through the hypoglossal canal. Persistent hypoglossal artery pha is the second most common anastomosis between the carotid and vertebrobasilar systems and demonstrates some variations.
Two cases of persistence of the primitive hypoglossal artery are reported with roentgenographic documentation of associated enlargement of the hypoglossal canal. None of the reports on pta variant, which is an anomalous cerebellar artery arising from the internal carotid artery without anastomosis to the basilar artery, has. Rare variant of persistent primitive hypoglossal artery. The key finding to distinguish the persistent hypoglossal artery from the proatlantal artery that has nearly the same orientation is the identification of the foramen through which the artery passes. The hypoglossal nerve holds this relation until it reaches the beginning of the occipital artery. Heart disease variants may also affect reproductive success. Spine, now in its third edition, showcases the latest cuttingedge research from dr. Persistent hypoglossal artery radiology reference article.
Persistent primitive hypoglossal artery ppha a rare. Manual aspiration thrombectomy for basilar infarction in the. Failure of regression of one or more of these primitive anastomoses leads to persistent carotidvertebrobasilar anastomoses, of which persistent primitive trigeminal artery is the most common type 14. The lingual artery, which supplies the tongue as well as the oral floor, is a major branch of the external carotid artery. The association of ppha with cerebral aneurysms has also rarely reported. Persistent primitive hypoglossal artery is a carotidvertebrobasilar anastomosis, which commonly arises from the internal carotid artery at the level of the c cervical vertebrae. A woman presented with 75% stenosis of the right internal carotid artery ica with extension to the origin of a persistent hypoglossal artery pha. A unique variant of a right persistent hypoglossal artery. Combined with occipital condyle the coronal appearance is reminiscent of an eagle seen in profile, making this a convenient landmark 3,4. Generally, pha is a clinically silent anatomical variation. It appears anteromedially from the external carotid artery, at the tip of the greater horn of the hyoid bone, between the superior thyroid artery and the facial artery. The hypoglossal nerve descends vertically through the retrostyloid space.
Herein is presented a case of a patient with a pha, who had undergone a cerebral angiography due to investigation of subarachnoid hemorrhage. Abstractthe persistent hypoglossal artery is rare vascular anomalies. Case report persistent primitive hypoglossal artery. The carotid artery may lie exposed within the middle ear cavity. Pha persistent primitive hypoglossal artery acronymattic. Rare variant of persistent primitive hypoglossal artery in. A persistent hypoglossal artery is one of the persistent carotidvertebrobasilar anastomoses. This is one of the persistent fetal anastomosis between the carotid and basilar systems and is usually asymptomatic. On coronal imaging, the jugular tubercle appears beaklike extending over the hypoglossal canal. At first, it is positioned medial to the internal carotid artery, but after that it crosses the artery and positions itself laterally to it. Additionally, the diagnostic alternatives for detection and assessment of pha and the. We report the case of a 50year old man with right hypoglossal artery, ipsilateral hypoplasic internal carotid artery, associated with left proximal subclavian stenosis with subclavian steal syndrome. Intracranial arterial variants, of which there are many, are collectively common.
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