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A persistent offender

Department of Radiology, Derriford Hospital, Derriford Road, Plymouth, UK

This excerpt was created in the absence of an abstract.

A 28-year-old lady presented with a 12 hour history of severe occipital headache. The onset of the headache was sudden. On examination there was mild neck stiffness with no focal neurological signs. The initial radiological examination was a head computed tomography (CT) scan which demonstrated a recent subarachnoid haemorrhage. The following day cerebral angiography was performed (Fig. 1).

What abnormalities are shown and what is the diagnosis?

The right common carotid arteriogram demonstrates a communication between the right internal carotid and the basilar arteries. This is caused by a persistent hypoglossal artery. The hypoglossal artery has a large aneurysmal sac close to its termination in the basilar artery. The sac is projected behind the terminal portion of the right internal carotid artery in Fig. lb. It can be identified clearly following a selective hypoglossal artery injection (Fig. 2). There is no retrograde filling of the distal portions of the vertebral arteries following this injection. The origins of the vertebral arteries could not be determined following selective injections into the innominate and left subclavian vessels.

Received for publication November 28, 1990. Revision received January 29, 1991. Accepted for publication February 22, 1991.