title: Transient Ischemic Attack in the Setting of Carotid Atheromatous Disease with a Persistent Primitive Hypoglossal Artery Successfully Treated with Stenting: A Case Report.
abstract: Fetal brain perfusion is supplied by the primitive dorsal aorta anteriorly, longitudinal neural arteries posteriorly, and anastomotic transverse segmentals. Most notable of these connections are the primitive trigeminal, otic, hypoglossal, and proatlantal arteries. With cranial-cervical circulatory maturation and development of the posterior communicating segments and vertebro-basilar system, these primitive segmental anastomoses normally regress. Anomalous neurovascular development can result in persistence of these anastomoses. Due to its territory of perfusion, the persistent primitive hypoglossal artery (PPHA) is associated with vertebral artery and posterior communicating artery hypoplasia or aplasia. As a consequence, primary blood supply to the hindbrain comes chiefly from this single artery. Although usually clinically silent, PPHA is susceptible to common cerebrovascular disorders including athero-ischemic disease and saccular aneurysmal dilation to name a few. We present a case of transient ischemic attack in a patient with a PPHA and proximal atherosclerotic disease treated by endovascular stenting.
authors.affiliation: Department of Neurosurgery, Houston Methodist Neurological Institute.
authors.forename: Meng
authors.initials: M
authors.lastname: Huang
authors.affiliation: Neurosurgery, Swedish Neuroscience Institute.
authors.forename: Marc
authors.initials: M
authors.lastname: Moisi
authors.affiliation: Anesthesiology and Critical Care, Houston Methodist Hospital.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Zwillman
authors.affiliation: Neurology, Houston Methodist Neurological Institute.
authors.forename: John J
authors.initials: JJ
authors.lastname: Volpi
authors.affiliation: Radiology, Houston Methodist Neurological Institute.
authors.forename: Orlando
authors.initials: O
authors.lastname: Diaz
authors.affiliation: Radiology, Houston Methodist Neurological Institute.
authors.forename: Richard
authors.initials: R
authors.lastname: Klucznik
keywords: atherosclerosis; hypoglossal; persistent; stent; tia