Top of the basilar syndrome associated with persistent primitive hypoglossal artery: A case report

Abstract

We report a patient with top of the basilar syndrome associated with persistent primitive hypoglossal artery (PPHA). A 94-year-old female was transported by ambulance because of disturbance of consciousness. She was in a deep coma. Her eyes were fixed in the middle position without pupillary light reaction. NIHSS score was 40. Head MRI demonstrated fresh infarction in the bilateral midbrain, cerebral peduncle, and thalamus. MRA demonstrated that the PPHA arose from the right internal carotid artery and formed the basilar artery (BA). BA was occluded in the end. Three-dimensional CT angiography after 4 days showed hypoplasia of the left vertebral artery and aplasia of the bilateral posterior communicating artery and the right vertebral artery. BA was recanalized, but the patient showed no improvement in symptoms. Because the development of collateral blood circulation was defective, top of the basilar syndrome may become severe in a patient with PPHA.