Multiple cerebral aneurysms associated with persistent primitive hypoglossal artery: Case report

Abstract

Persistent primitive hypoglossal artery (PPHA) is frequently associated with an intracranial aneurysm as previously reported. We report here our experience with a case of PPHA associated with multiple cerebral aneurysms. A 59-year-old woman was brought to our hospital suffering from severe headache and vomitting. A subarachnoid hemorrhage (SAH), which was classified as Fisher group 2, was confirmed by CT scan. Cerebral angiography revealed the two aneurysms, one located at the anterior communicating artery and the other at the top of the basilar artery, a right persistent primitive hypoglossal artery was identified. The right vertebral artery was aplastic, and the left vertebral artery was hypoplastic. A diagnosis of SAH (Hunt & Kosnik Grade II) due to a ruptured anterior communicating artery aneurysm was made and an operation was performed at day 4, comprising a right frontotemporal craniotomy and an anterior clinoidectomy. Both aneurysms were treated by neck clipping through the pterional approach with no intraoperative trouble. Postoperative course was uneventful, and 3D-CTA was available with the diagnosis of PPHA. The second angiography was carried out at day 14, and revealed that both aneurysms were completely clipped. The patient was discharged with no neurological deficits. It was suggested that a congenital fragility of the vessel wall, in addition to hemodynamic stress and hypertension, had influence on the etiology of this aneurysm associated with PPHA.