Subarachnoid Haemorrhage due to Rupture of an Aneurysm on a Persistent Left Hypoglossal Artery

Abstract

The presence of persistent carotid-basilar anastomosis is well known. From autopsy studies such communications along the first division of the 5th nerve (trigeminal artery) and along the auditory and hypoglossal nerves (persistent auditory and hypoglossal arteries) have been described. Since the first demonstration by Sutton (1950) a large number of cases of the trigeminal variation of these persistent arterial channels demonstrated by angiography have been published (Krayenbühl, 1957). There have been 11 cases in the arteriographic records of the Johns Hopkins Hospital since 1949. However, only five cases have been reported in the literature of a persistent hypoglossal artery (Morris and Moffat, 1956), and only one case was demonstrated by carotid arteriography (Begg, 1961).* There is no reference to an aneurysm arising from the persistent hypoglossal artery. D.N., JHH 1034675, a 26-year-old stoker, was seen in the emergency room of the Johns Hopkins Hospital because of sudden onset of severe occipital headache. This was persistent and he had had to stop work and sit down immediately. Profuse sweating followed. He never lost consciousness, but was drowsy upon arrival. He had not vomited. He gave a history of diurnal headache localised behind the left eye, which was thought to be migrainous in character. The only significant physical findings were neck stiffness and right facial weakness. A lumbar puncture showed grossly blood-stained fluid with a haematocrit of 18 and a pressure of 330 mm of water.