Persistent Primitive Hypoglossal Artery with Ipsilateral Symptomatic Carotid Artery Stenosis and Cerebral Aneurysm
| Autor: | Naohide Fujita, Yoshitaka Ito, Takuji Yamamoto, Takaoki Kimura, Joji Tokugawa, Yasuaki Nakao, Mitsuya Watanabe, Kaito Kawamura, Shinichiro Teramoto |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test Cerebral infarction business.industry medicine.medical_treatment Rehabilitation Infarction Carotid endarterectomy Digital subtraction angiography medicine.disease Stenosis Aneurysm Embolism medicine.artery cardiovascular system medicine Surgery cardiovascular diseases Neurology (clinical) Radiology Internal carotid artery Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Stroke and Cerebrovascular Diseases. 30:106099 |
| ISSN: | 1052-3057 |
| DOI: | 10.1016/j.jstrokecerebrovasdis.2021.106099 |
| Popis: | Objective Persistent primitive hypoglossal artery (PPHA) is a rare type of persistent carotid-basilar anastomosis sometimes associated with other vascular lesions. We treated an extremely rare case of PPHA with concomitant ipsilateral symptomatic cervical internal carotid artery (ICA) stenosis and unruptured aneurysm. Case presentation A 67-year-old woman visited our institution with acute onset of diplopia. Magnetic resonance imaging revealed multiple acute infarctions in the right anterior and posterior circulations. Digital subtraction angiography demonstrated the right PPHA concomitant with ipsilateral cervical ICA stenosis and an unruptured ICA aneurysm with maximum diameter of 8 mm. The multiple infarctions were considered to result from artery-to-artery embolism due to microthrombi from the ICA plaque passed along the PPHA, so carotid endarterectomy was performed as the first step with preoperative modified Rankin Scale (mRS) grade 1. During the operation, the patient had impaired ICA perfusion due to internal shunt catheter migration into the PPHA followed by acute infarction in the right hemisphere causing mild left hemiparesis. The patient was transferred to the rehabilitation hospital with mRS grade 3. After 3 months of rehabilitation, the patient recovered to mRS grade 1 and clipping surgery for the unruptured right ICA aneurysm was performed as the second step with uneventful postoperative course. Conclusion The treatment strategy should be carefully considered depending on the specific blood circulation for such cases of PPHA with unique vasculature. |
| Databáze: | OpenAIRE |
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