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Case Reports
. 2020 Jul-Sep;30(3):383-385.
doi: 10.4103/ijri.IJRI_429_19. Epub 2020 Oct 15.

Unusual case of persistent primitive hypoglossal artery with anterior choroidal artery aneurysm in Chiari type I malformation

Shinya Haryu  1   2 , Naoki Shida  2 , Teiji Tominaga  1
Affiliations
Case Reports

Unusual case of persistent primitive hypoglossal artery with anterior choroidal artery aneurysm in Chiari type I malformation

Shinya Haryu et al. Indian J Radiol Imaging. 2020 Jul-Sep.

Abstract

Persistent primitive hypoglossal artery (PPHA) is a rare form of persistent embryonic carotid-basilar anastomosis. We present an unusual case of PPHA and an anterior choroidal artery (AChoA) aneurysm associated with Chiari type I malformation. A 45-year-old woman presented with transient dizziness. Magnetic resonance imaging revealed Chiari type I malformation and a left AChoA aneurysm. Digital subtraction angiography incidentally revealed a left PPHA. To the best of our knowledge, this is the first reported case of Chiari malformation in conjunction with PPHA and aneurysms. In this case, the perfusion of the posterior circulation is completely dependent on PPHA. It is very important to identify such variant vessels and complex angioarchitecture before planning neuroendovascular or surgical intervention to prevent possible risks.

Keywords: Aneurysm; Chiari malformation; anterior choroidal artery; persistent primitive hypoglossal artery.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1(<b>A and B</b>)
Figure 1(A and B)
Midsagittal T1-weighted image of magnetic resonance imaging indicated caudal displacement of the cerebellar tonsils 10 mm below the level of the foramen magnum and descent of the fourth ventricle below Twining's line (A). Midsagittal T2-weighted image showed no syringomyelia (B). These findings led to the diagnosis of Chiari type I malformation without syringomyelia
Figure 2(<b>A-F</b>)
Figure 2(A-F)
Catheter angiography revealed a left persistent primitive hypoglossal artery (PPHA) and an anterior choroidal artery aneurysm (arrow) (A, left anterior oblique view; B, front view; C, lateral view). PPHA passed through the hypoglossal canal (D). Perfusion of basilar artery was dependent on PPHA (E, front view; F, lateral view)
Figure 3
Figure 3
(A-F): Left internal carotid angiography, including three-dimensional rotational angiography (3DRA), revealed an anterior choroidal artery aneurysm (A-D). 3DRA and computed tomography angiography showed that the aneurysm was located at a low position very close to the posterior clinoid process (E and F)
See this image and copyright information in PMC

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