IJCS | Volume 31, Nº5, September / October 2018

549 Figure 1 - (A) Magnetic resonance showing diffusion restriction in the brain stem on the left. (B) Angiotomography with MIP reconstruction and bone subtraction, demonstrating the emergence of the hypoglossal artery and the left internal carotid artery. (C) Comparative image between the two carotid arteries and the emergence of the primitive hypoglossal on the left. Left internal carotid artery Primitive hypoglossal Left internal carotid artery Primitive hypoglossal Souto et al. Primitive hypoglossal artery in an elderly patient Int J Cardiovasc Sci. 2018;31(5)548-550 Case Report PPHA is often identified in imaging tests; however, in the presence of atherosclerotic disease, it may be of clinical importance due to the increased chance of developing cerebral infarction. 6,7 Associated with this condition, the passage of emboli from the internal carotid artery to the vertebrobasilar system becomes possible. 8 Our patient did not receive dual antiplatelet therapy due to the hemorrhagic transformation of the CVA and was submitted to an expectant conduct, as recommended by the literature. 9 The drainage of bulky hematomas is essential for the maintenance of life, but more discrete hemorrhagic events can be followed without major interventions, 9 as in this case. Conclusion The above case report showed the clinical importance of the persistence of primitive arteries, more specifically the primitive hypoglossal artery, in a context of cerebrovascular accident and its consequences. Author contributions Conception and design of the research: Souto RM, Santos AASMD, NacifMS. Acquisition of data: Souto RM, Nacif MS. Analysis and interpretation of data: Souto RM, Nacif MS. Writing of the manuscript: Souto RM, Nacif MS. Critical revision of the manuscript for intellectual content: Souto RM, Santos AASMD, Nacif MS. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This article is part of the thesis of master submitted by Rafael Mansur Souto, from Universidade Federal Fluminense (UFF).