Abstract
The persistence of the hypoglossal artery is a rare embryonic vascular variant in which a transient connection between the carotid and vertebrobasilar systems fails to regress. Typically asymptomatic and incidentally discovered on imaging, this condition can alter cerebral blood flow and increase the risk of vascular complications such as aneurysms, strokes, and arteriovenous malformations. We present the case of a 70-year-old female with no prior medical history who was admitted to the emergency department with right-sided hemiparesis. A cerebral CT angiography, performed to evaluate for acute ischemic stroke and potential thrombolysis, revealed a persistent hypoglossal artery arising from the internal carotid artery at the C1-C2 level and connecting to the basilar artery through the hypoglossal canal. This case highlights the importance of recognizing this rare anatomical variant on imaging to prevent misinterpretation and avoid complications during surgical or endovascular interventions at the skull base.