Persistence of foetal anastomoses between carotid and vertebrobasilar arteries is a well-known anomaly, although bilateral persistence of these anastomoses is uncommon. Persistent hypoglossal artery is one of the four anastomotic vessels between the carotid and the vertebrobasilar arterial systems. Persistence of bilateral hypoglossal arteries with other associated anomalies is exceptionally uncommon and may result in unusual symptoms or have implications for therapy. We report an incidentally detected case of bilateral persistent hypoglossal arteries with an associated finding of hypoplastic vertebral arteries, describe their embryology and consider the potential clinical implications of this finding.