Cerebral infarction in both carotid and vertebrobasilar territories associated with a persistent primitive hypoglossal artery with severe dilated cardiomyopathy.

A persistent primitive hypoglossal artery (PPHA) is a relatively rare vascular anomaly of a persistent carotid-basilar anastomosis. A 76-year-old man with severe dilated cardiomyopathy suddenly lost consciousness. A magnetic resonance imaging scan of his brain revealed extensive infarction in the carotid and vertebrobasilar territories. Magnetic resonance angiography revealed a PPHA and occlusion of the left internal carotid artery and vertebrobasilar artery. Cardioembolic infarction associated with a PPHA should be recognized as a possible cause of multiple infarctions in both the carotid and vertebrobasilar distributions in the absence of stenotic ICA lesions.