PMC9760743_01
Magnetic resonance imaging and angiography. (A) Magnetic resonance imaging (A,B) and magnetic resonance angiography (C) performed in a local hospital showed a left persistent primitive hypoglossal artery converging into the proximal part of the basilar artery (arrow) and aneurysm of the left posterior communicating artery segment of the ICA (arrow head).
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Magnetic resonance angiography performed in a local hospital reported an aneurysm of the posterior communicating artery segment of the left ICA and a left PPHA (Figure 1).
Digital subtraction angiography. Anteroposterior (A) and lateral (B) left carotid artery angiograms show the PPTA (arrow) originating from the left cervical segment of the ICA and converging to the proximal part of the basilar artery. An extremely coiling segment of the ICA similar to a ball of string exists close to the beginning of PPHA distally (arrow head). The left occipital artery (asterisk) arises from the cervical segment of the ICA rather than the external carotid artery (forked tail) and is close to the beginning of PPHA proximally. 3D DSA shows two aneurysms at the coiling part of the ICA (C,D) (arrow) and an aneurysm at the posterior communicating artery segment of the ICA (E) (arrow). Anteroposterior left and right vertebral artery angiograms (F,G) demonstrate that bilateral vertebral arteries are hypoplastic with a small caliber. Posterior communicating arteries were not visualized bilaterally through left and right lateral carotid artery angiograms (B,H). Anteroposterior (I) and lateral (J) right carotid artery angiograms show that the right extracranial ICA (arrowhead) is a normal tortuosity type and that the right occipital artery (asterisk) arises from the right ECA (forked tail).
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Further digital subtraction angiography (DSA) was performed after admission and showed a PPHA originating from the left cervical segment of the ICA and converging to the proximal part of the basilar artery (Figures 2A,B). ICA, such as a ball of string, distally exists close to the beginning of PPHA (Figure 2B; Supplementary Video 1). In addition, two small aneurysms were found at the coiling segment of the ICA, measuring 1.9 x 1.6 mm and 1.4 x 1.1 mm (Figures 2C,D). The aneurysm of the posterior communicating artery segment of the left ICA was also confirmed by DSA and measured 3.8 x 3.4 mm (Figure 2E). PPHA (Figures 2F,G). Posterior communicating arteries were not visualized bilaterally (Figures 2B,H). The left occipital artery arises from the cervical segment of the ICA rather than the external carotid artery (ECA) and is close to the beginning of PPHA proximally (Figure 2B). Except for the anomalies mentioned above, the right extracranial ICA is a normal tortuosity type (Figure 2I). However, the right occipital artery arose from the right ECA (Figure 2J).