Internal carotid artery stenosis associated with ipsilateral persistent hypoglossal artery presenting as a multi-territorial infarction : Case report

遺残舌下動脈（persistent hypoglossal artery，PHA）を分岐する内頸動脈の狭窄病変により内頸動脈系および椎骨動脈系の塞栓症を同時に発症した1例を報告する．症例は73歳男性．右頸部内頸動脈狭窄とPHAを指摘されていた．突然の意識障害などをきたして搬送された．意識障害（JCS II-10），眼球運動障害，皮質盲，左不全片麻痺が存在し，MRIにて右前頭葉，両側後頭葉，脳幹，両側小脳に急性期の梗塞巣を認めた．保存的治療およびリハビリを行ったが，両側皮質盲を後遺した．諸検査にて心原性塞栓は否定され，右頸部内頸動脈狭窄症に起因するartery-to-artery embolismが内頸動脈，PHAを介して多発性脳梗塞をきたしたと考えられた．PHAを合併した内頸動脈狭窄症による脳梗塞はわずかに報告されているのみであり，その診断や治療については注意が必要である．Persistent hypoglossal artery (PHA) is a relatively rare vascular anomaly of persistent carotid-basilar anastomosis and is usually asymptomatic. In this report, we describe a 73-year-old male patient who was admitted to our hospital due to sudden consciousness disturbance, right oculomotor palsy, left MLF syndrome, bilateral cortical blindness, and severe left hemiparesis. MRI/A at admission revealed acute cerebral infarction in both the carotid and vertebral artery territories, and moderate internal carotid artery stenosis associated with ipsilateral PHA. Artery-to-artery embolism from the internal carotid artery is thought to be the cause of this multiterritorial infarction. It should be borne in mind that persistent carotid-basilar anastomosis can cause multi-territorial cerebral infarction mimicking cardioembolism, and may be a candidate for aggressive prophylactic intervention when complicated by occlusive carotid artery diseases