Bilateral persistent carotid-basilar anastomoses

Posterior fossa transient ischemic attack in the setting of bilateral persistent hypoglossal arteries: A case report and literature review

RATIONALE

Persistent hypoglossal artery (PHA) is the second rare abnormal anastomosis of the internal carotid and vertebrobasilar arteries, and bilateral persistent hypoglossal arteries in particular have rarely been reported. This is the first case of bilateral persistent hypoglossal arteries presenting with posterior fossa transient ischemic attack (TIA).

PATIENT CONCERNS

We reported a 54-year old female with posterior fossa TIA due to the coexisting bilateral persistent hypoglossal arteries and left internal carotid artery stenosis.

DIAGNOSIS

The patient was diagnosed with posterior fossa TIA, bilateral persistent hypoglossal arteries and left internal carotid artery stenosis.

INTERVENTIONS

The patient was given aspirin 100 mg/qd and advised to avoid excessive neck movement.

OUTCOMES

Symptoms of intermittent subjective dizziness accompanied by nausea were relieved.

LESSONS

Although requires no special treatment, PHA could be accompanied by hypoplasia of vertebral arteries and posterior communicating arteries and becomes the main blood supply pathway for the posterior circulation. Accurate identification and evaluation of PHA is important of ensuring the safety of carotid interventions and identifying specific types of stroke.

Bilateral persistent primitive hypoglossal artery presenting with hemiplegia✰

The manuscript describes an unusual vascular anomaly. Persistence of carotid-vertebrobasilar anastomosis is a rare occurrence with presence of bilateral hypoglossal arteries (HAs) rarer still. We present a case of bilateral persistent HAs with hypoplastic vertebral arteries which end into posterior inferior cerebellar arteries. The computed tomography and magnetic resonance imaging appearance, course, and other associations are discussed. A review of 6 cases of bilateral HA published in the world literature is also discussed.

Unilateral Aplasia versus Bilateral Aplasia of the Vertebral Artery: A Review of Associated Abnormalities

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. Incidence, gender, persistence of carotid-vertebrobasilar anastomosis (CVBA), associated with other vascular variants, and vascular pathology in each group of uni- and bilateral VA aplasia are mutually compared. Most of the cases of VA aplasia in ages 31 to 80 were discovered in USA, Japan, and India. The bilateral VA aplasia is more common in the male gender than in the female one. The side of the VA aplasia had a significant effect on the side of CVBA persistence. Associated aplasia of other arteries was more common in cases of unilateral VA aplasia. The left VA was more commonly hypoplastic in cases of single right VA aplasia than the right VA in cases of single left VA aplasia. Aneurysms of definitive arteries were more frequent in cases of single right VA aplasia than in cases of single left VA aplasia. We claim that the aplasia of the VA probably depends on genetic factors in some races, while diseases are expressed usually in persons over 30 years of age.

Bilateral persistent primitive hypoglossal arteries associated with unilateral symptomatic carotid thromboembolism

We report the fifth case of bilateral persistent primitive hypoglossal arteries in the literature. This is also the first such case to be demonstrated on computerized tomography angiogram (CTA) and the first case to be associated with a symptomatic carotid thrombus. The sub-occlusive thrombus was distal to the take-off of the dominant persistent hypoglossal artery (PHA) from the internal carotid artery, thus sparing involvement of posterior circulation. Timely identification of the internal carotid artery thromboembolism in the setting of a PHA is important to allow for thrombectomy. Any intervention was not done in this case as the patient was out of the window and at an additional risk of inducing intracranial thromboembolism. Symptomatic carotid stenosis at the PHA take-off is typically treated with endovascular angioplasty and stenting due to the typically high level of the bifurcation in the neck.

Persistent hypoglossal arteries with aneurysmal dilation of left hypoglossal artery: a rare case report and review of the literature

Persistence of foetal anastomoses between carotid and vertebrobasilar arteries is a well-known anomaly, although bilateral persistence of these anastomoses is uncommon. Persistent hypoglossal artery is one of the four anastomotic vessels between the carotid and the vertebrobasilar arterial systems. Persistence of bilateral hypoglossal arteries with other associated anomalies is exceptionally uncommon and may result in unusual symptoms or have implications for therapy. We report an incidentally detected case of bilateral persistent hypoglossal arteries with an associated finding of hypoplastic vertebral arteries, describe their embryology and consider the potential clinical implications of this finding.

Bilateral persistent hypoglossal arteries: MRI findings

Persistence of foetal anastomoses between carotid and vertebrobasilar arteries is well recognised, but their bilateral presence is rare. We report a case of bilateral persistent hypoglossal arteries. Absence of bilateral vertebral arteries was incidentally noted on neck ultrasound examination. Subsequent MRI confirmed this and revealed persistent hypoglossal arteries that arose bilaterally from the cervical internal carotid artery, entered the cranium through the hypoglossal canal and joined the lower portion of the basilar artery.

Persistence of the otic artery with neurological sequelae: case report

Persistence of intracranial fetal vasculature may be encountered by the neurosurgeon. Of these, the otic artery is extremely rare and to some, a true case has to date, not been authenticated. We report an adult patient found to harbor an otic artery. Moreover, neurological sequelae of this fetal vascular connection are believed to have occurred. This case and a review of germane literature are presented.

Persistent fetal intracranial arteries: a comprehensive review of anatomical and clinical significance

As fetal intracranial vessels may persist into adulthood, knowledge of their anatomy and potential clinical and surgical complications should be borne in mind by the surgeon. A comprehensive review of these vessels, however, is not easily identified in the literature. Therefore, the present analysis was undertaken so that such information is available to the clinician and morphologist.

Bilateral persistent trigeminal arteries presenting with brain-stem infarction

A 43-year-old male with a left hemiparesis due to brain-stem infarction associated with bilateral persistent trigeminal arteries is reported. The clinicopathological and radiographic significance of persistent carotid-basilar arterial anastomoses in vertebrobasilar territory ischaemic attacks is also discussed.

Transient bilateral occipital lobe ischemia: microembolization through a trigeminal artery

Microembolization from an ulcerated carotid artery to both occipital lobes via a persistent trigeminal artery was observed in a patient presenting with episodic bilateral central scotomata. Symptomatic relief was obtained following carotid endarterectomy. This unique pathway which resulted in occipital lobe ischemia has not been previously reported.