Angiographic findings and clinical implications of persistent primitive hypoglossal artery

Herein is presented a case of a patient with a PHA, who had undergone a cerebral angiography due to investigation of subarachnoid hemorrhage. Additionally, the diagnostic alternatives for detection and assessment of PHA and the spectrum of diseases related to its presence are discussed.The presence of a persistent PHA can be recognized as an incidental finding in a cerebral angiography without any other clinical implication or may be associated with certain clinical entities such as aneurysm formation and atherosclerotic disease.A 51-year old man admitted to the emergencies of our Hospital, due to an episode of loss of consciousness. The chest X-ray (CXR), electrocardiogram (ECG) and first laboratory findings were normal and his medical history was remarkable for arterial hypertension, hypercholesterolemia and cigarette smoking. The patient underwent an unenhanced emergency cranial CT scan during the first hour of his admission, which revealed moderate subarachnoid hemorrhage (Fig. 1). The patient recovered completely after some hours and scheduled for a cerebral digital subtraction angiography, in order to exclude the presence of an aneurysm or an arteriovenous malformation.The angiography performed by Seldiger percutaneous puncture of the right femoral artery and selective catheterization of the right and left carotid artery and both vertebral arteries. There was no aneurysm or arteriovenous malformation demonstrated at this study. Instead, the selective catheterization of the left carotid artery disclosed a large persistent PHA originating from the internal carotid artery at the level of C2, which continued as basilar artery (Fig. 2). The catheterisation of the left subclavian artery demonstrated absence of the left vertebral artery whereas the right vertebral artery appeared hypoplastic (Fig 3). The right carotid artery appeared normal. Both posterior communicating arteries were visualised. The first angiogram in this particular patient did not reveal any vascul