持续性原始舌下神经动脉(PPHA)是导致持续性颈动脉-椎基底动脉吻合的解剖学变体。此变体来自C1和C3之间的颈内动脉(ICA)的远端颈段,并穿过扩大的舌下管以连接基底循环。该病例报告描述了一名60岁的男性,其急性缺血事件继发于右侧ICA和PPHA的闭塞,导致独特的体检。数字减影血管造影(DSA)用于可视化右颈总动脉闭塞,没有残留的右颈内动脉或右椎动脉充盈。患者出现的症状产生了独特的神经系统检查,很难定位孤立性病变,这可以解释病人的急性表现。回想起来,血管造影显示正确的PPHA,他的演讲更符合临床情况。随着神经血管内手术的效用增加,临床医生有更高的概率遇到不同的血管造影结果。有了这个病例报告,我们想让从业者熟悉PPHA的存在,呈现独特的影像学发现,涉及通常孤立的血管区域,并强调在做出有关中风护理的决定时临床判断的重要性。
A persistent primitive hypoglossal artery (PPHA) is an anatomical variant resulting in persistent carotid-vertebrobasilar anastomoses. This variant arises from the distal cervical segment of the internal carotid artery (ICA) between C1 and C3 and passes through an enlarged hypoglossal canal to join the basilar circulation. This case report describes a 60-year-old male with an acute ischemic event secondary to an occlusion in the right ICA and PPHA, resulting in a unique physical examination. Digital subtraction angiography (DSA) was utilized to visualize occlusion of the right common carotid artery with no residual right internal carotid artery or right vertebral artery filling. The patient\'s presenting symptoms yielded a unique neurological examination, making it difficult to localize a solitary lesion, which would account for the patient\'s acute presentation. In retrospect, with angiography revealing a right PPHA, his presentation fit more thoroughly with the clinical picture. With the increased utility of neuro-endovascular procedures, clinicians have a higher probability of encountering diverse angiographical findings. With this case report, we would like to familiarize practitioners with the presence of PPHA, present unique imaging findings involving typically isolated vascular territories, and stress the importance of clinical judgment when making decisions regarding stroke care.