• Angelo Maurizio Clerici, Giuseppe Craparo, Giuseppina Cafasso, Camilla Micieli, and Giorgio Bono.
• Neurology Unit, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri 57, 21100, Varese, Italy. mau.cle@libero.it
• J Headache Pain. 2011 Dec 1;12(6):639-43.

AbstractWe report the case of a 56-year-old man with acute onset of de-novo stabbing, pulsating and diffuse headache with subsequent appearance (within few minutes) of posterior fossa symptoms (vomiting, postural instability, anisocoria, incoordination, dysarthria, retropulsion) lasting 9-12 h. Recurrent hypertensive crises were detected during the acute observation in the Emergency Room, even in the absence of previous history of hypertension. Once subarachnoid hemorrhage and focal lesions (vascular and non-vascular) were excluded, brain computerized tomography-angiography and digital subtraction angiography disclosed the presence of left persistent primitive hypoglossal artery with bilateral vertebral artery hypoplasia and a slight aneurysmal dilation of the anterior communicating artery. Brain magnetic resonance study performed 24 h after onset of symptoms was negative for recent ischemic lesions. The clinical features of this rare vascular condition are discussed as a possible cause of magnetic resonance (diffusion weighted imaging) negative vertebro-basilar transient ischemic attack.

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