THE PERSISTENT PRIMITIVE HYPOGLOSSAL ARTERY - A RARE ANATOMIC VARIATION WITH FREQUENT CLINICAL IMPLICATIONS

The case of a persistent primitive hypoglossal artery (PHA) in a 72-ye ar-old man dead from myocardial infarction is presented. The autopsy s howed the presence of a semicircular marginal infarct on the surface o f the left cerebral hemisphere. The PHA anastomized the basilar artery origin with the left internal carotid artery, running through the lef t hypoglossal canal together with the hypoglossal nerve. The vertebral and posterior communicating arteries were hypoplastic. The PHA repres ented the morphological base on which the cerebral vascular insufficie ncy acted, following the generalized circulatory insufficiency due to the myocardial infarct, causing the cerebral infarct. Based on the emb ryology of the cranial arteries and on the morphological findings we s uggest that the persistence of the hypoglossal artery: 1) precedes the vertebral and posterior communicating arteries hypoplasia causing it by competition for the territory of distribution; 2) gives rise to an almost complete dependence of the cerebral circulation from the caroti d system with predictable ischemic consequences in the case of a criti cal reduction of the carotid blood flow; 3) may be associated with an anomalous structure of the vessel wall and exposes the basilar trunk t o an unusual haemodynamic stress, predisposing to the onset of aneurys ms.