[A case of Coexistent Persistent Trigeminal and Hypoglossal Arteries Manifested with Neurovascular Compression Syndrome by Hypertension].

A 70-year-old woman visited our hospital with hypertension, diplopia, and right orbital pain. Neurological examination revealed right ophthalmoplegia. CT angiography and MRI identified a right persistent trigeminal artery (PTA), right persistent hypoglossal artery, and bovine aortic arch. The right internal carotid artery (ICA) was displaced laterally in the cavernous sinus due to the bifurcation of the PTA. Compression of the right oculomotor nerve, right trochlear nerve, and first division of the right trigeminal nerve by the elongated right ICA was noted and considered a potential cause of the ophthalmoplegia and orbital pain. Symptoms improved with normalization of blood pressure. During embryonic development, the right posterior communicating artery and bilateral vertebral arteries were aplastic or hypoplastic, which suggests that these carotid-basilar anastomoses may have remained as supply routes to provide sufficient blood flow to the posterior cerebral circulation. This is an extremely rare case of embryological implications manifested with neurovascular compression syndrome. (Received 6 January, 2022; Accepted 17 February, 2022; Published 1 June, 2022).

Intracranial atypical fibromuscular dysplasia with ruptured aneurysm--case report.

A 53-year-old woman was admitted with severe subarachnoid hemorrhage due to rupture of an aneurysm associated with atypical intracranial fibromuscular dysplasia (FMD). Angiography demonstrated the aneurysm and very irregular form of the left internal carotid artery (ICA), the right ICA, and right proximal middle cerebral artery (MCA). Other arteries showed signs of atherosclerosis. The aneurysm was treated by embolization, but she subsequently died of shock of unknown cause. Detailed examination of serial angiograms detected enlargement of the aneurysm and progression of the irregular appearance of the ICA. FMD is a non-inflammatory and non-atheromatous arteriopathy that commonly affects the cervical ICA and sometimes the intracranial ICA. The association with saccular aneurysm is widely known and the prevalence of incidental aneurysms is higher than that in the general population. The common "string of beads" finding is easily distinguished from other vascular diseases, but non-specific findings such as "tubular stenosis" and "diverticular-like outpouching" are harder to differentiate. FMD is associated with various complications and appropriate periodic follow-up examination is required. Detailed analysis of serial angiograms may facilitate diagnosis of this condition.