A rare case of persistent hypoglossal artery associated with contralateral proximal subclavian stenosis

Congenital internal carotid artery hypoplasia: A systematic review

This review evaluates the current evidence for the clinical management of congenital internal carotid artery hypoplasia (CICAH). We summarise clinical presentations diagnostic standards, imaging recommendations, treatment and follow-up. The review was prompted by a case of CICAH in a 50-year-old female who presented to our neurosurgery clinic with an acute episode of vertigo. The patient underwent CT angiogram, which showed an unusually low right carotid bifurcation. The right internal carotid artery (ICA) was hypoplastic, and the A1 segment of the anterior cerebral artery (ACA) was absent. Skull base CT showed an ipsilateral hypoplastic carotid canal. To summarise current evidence for clinical management of CICAH we followed PRISMA guidelines to identify papers meeting our predefined inclusion criteria. We searched three databases using the terms 'ICA' and 'Hypoplasia'. We reviewed 41 papers meeting our criteria. 34 were clinical reports. We performed a data extraction and quality appraisal on these reports. We found that CICAH may be less rare than previously described. Blood pressure control in CICAH is crucial due to the increased risk of stroke and aneurysm formation. Follow-up imaging is strongly recommended. Carotid doppler sonography is a powerful and underutilised diagnostic tool, and carotid canal hypoplasia is not a pathognomic sign. In conclusion, clinicians should be alert to anatomic variations such as CICAH because these produce haemodynamic changes that may have serious clinical consequences. We recommend a central registry of patients with CICAH in order to understand the longer-term natural history of the condition.

A unique variant of a right persistent hypoglossal artery arising from the common carotid artery with complex cardiovascular anomalies in a female neonatal patient

Persistent primitive hypoglossal artery is a carotid-vertebrobasilar anastomosis, which commonly arises from the internal carotid artery at the level of the C (cervical) 1-3 vertebrae. We describe a unique case of a female infant patient with this anomaly that has an unusually low origin from the distal common carotid artery just below the bifurcation at the level of roughly C5 and supplies the entire vertebrobasilar system. Additional cardiovascular anatomical variations were present: Tetralogy of Fallot and a right-sided aortic arch with mirror image branching. These singular variations are rare in the general population, but even rarer when combined. Awareness of these unusual vascular variants is clinically significant, as they may predispose the patients to early ischemic injury, hemorrhage, aneurysm formation, and can be essential in surgical planning. Therefore, radiographic imaging is of importance in proper diagnosis of such variants.