Bilateral occipital infarcts associated with carotid atherosclerosis and a persistent hypoglossal artery.
The persistent hypoglossal artery (PHA) is the second most common persistent embryological carotid-basilar connection and usually represents an incidental finding in cerebral arteriograms. The hypoglossal artery connects the primordial carotid artery with the longitudinal neural arteries, which later form the basilar artery. The PHA leaves the internal carotid artery as an extracranial branch, enters the skull through the anterior condyloid foramen, the hypoglossal canal and joins the caudal portion of the basilar artery. We report magnetic resonance and digital subtraction angiography findings in the first case of bilateral occipital infarctions associated with PHA and carotid atherosclerosis. The probable mechanism underlying bilateral occipital infarcts was embolism from the carotid territory to the posterior cerebral arteries. PHA may present a challenge in diagnosis and management of patients with carotid atherosclerosis and vertebrobasilar ischemia.
Conforto
Adriana Bastos
AB
Neurology Division, Hospital das Clínicas/São Paulo University, Brazil. abconf@usp.br
de Souza
Murilo
M
Puglia
Paulo
P
Yamamoto
Fábio Iuji
FI
da Costa Leite
Claudia
C
Scaff
Milberto
M
D000368:Aged; D015901:Angiography, Digital Subtraction; D001488:Basilar Artery / Q000002:abnormalities* / Q000473:pathology; D002343:Carotid Artery, Internal / Q000002:abnormalities* / Q000473:pathology; D016893:Carotid Stenosis / Q000175:diagnosis*; D002531:Cerebellum / Q000098:blood supply / Q000473:pathology; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000175:diagnosis*; D004292:Dominance, Cerebral / Q000502:physiology*; D006423:Hemianopsia / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D033162:Incidental Findings; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis; D020762:Infarction, Posterior Cerebral Artery / Q000175:diagnosis; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D009778:Occipital Lobe / Q000098:blood supply*; D013788:Thalamus / Q000098:blood supply / Q000473:pathology; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler; D014711:Vertebral Artery / Q000002:abnormalities* / Q000473:pathology