Persistent primitive hypoglossal artery: a case study with a dissertation on its embryo-pathological rationale

Persistent Primitive Hypoglossal Artery (PPHA) is a developmental anomaly of the brain superficial arterial circulation and is classified as a condition of carotid-vertebrobasilar anastomosis persistence caused by lack of reabsorption of the vascular network running on the hindbrain surface between the 4th and 5th embryonic week. It has an incidence between 0.03 and 0.9%, it is the second most frequent seen persistence of carotid-vertebrobasilar anastomoses after the trigeminal artery (TA), representing 85% of all persistent vestigial arteries (0.1–0.6%). Here a case of Persistent Primitive Hypoglossal Artery (PPHA) is reported being detailed in its morphological and clinical aspects. The patient, a 55-year-old female patient with high cardiovascular risk without specific symptoms presents at radiological morphological examination with an anomalous bifurcation of the ICA which gives rise to the ICA itself, which ascends without collateral branches up to the carotid foramen in the cranial base, and to an accessory artery, which enters the hypoglossal canal on the contour of the great occipital foramen, as a PPHA. A comprehensive embryologic analysis of this anatomical variant is offered and clinical awareness on it raised in view of a more informed an effective realization of it in daily clinical practice.