Persistent Hypoglossal Artery

Findings:

There is a left persistent hypoglossal artery giving origin to the left vertebral artery. The left PICA originates in the left hypoglossal canal. There is a small right vertebral artery. The remainder of the vertebral basilar system is normal in appearance

Discussion/Differential Diagnosis:

Persistent Hypoglossal Artery (PHA) is the second most common persistent carotid-vertebrobasilar anastomosis. Found in 0.03-0.26% of angiograms, they are second to Persistent Trigeminal Arteries which are found in 0.1-0.2% of cerebral angiograms. The PHA will usually arise from the distal cervical internal carotid artery and will join the basilar artery inferiorly after passing through the hypoglossal canal which will be enlarged. If the PHA is large enough the vertebral artery and post communicating artery will be very small or absent. Other persistent carotid-vertebrobasilar anastomoses include Persistent otic artery (POA) and Proatlantal intersegmental artery (PIA) which are both very rare.

Case contributed by Josh Hall, UC undergraduate

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