A persistent primitive hypoglossal artery (PPHA) is rare vascular anomaly with an incidence of 0.02%-0.26%. PPHA is the second most common carotid-vertebrobasilar artery anastomosis DÑ–er trigeminal artery. PPHA is usually an incidental findLnJ in most of the cases however it may be associated with intracranial aneurysm, arteriovenous malformation, glossopharyngeal neuralgia and hypoglossal palsy. We report a rare case of incidentally detected PPHA in patient with midline falx meningioma diagnosed on magnetic resonance imaging (MRI) as aberrant floZ void structure (artery) coursing through the right hypoglossal canal. It was later confirmed on digital subtraction angiography (DSA) of brain and neck vessels. A 40 year old male patient presented with history of chronic daily headache for 5 months which was not controlled with medications. MRI was done which showed a falx meningioma and an incidental anomalous artery with floZ void coursing through the right hypoglossal canal. Patient was advised surgical resection of the tumor. In view of atypical imaging findLnJs for meningioma, DSA was planned preprocedural to assess the tumor vascularity and to perform endovascular embolization if required. Right internal carotid artery (ICA) injection showed an anomalous artery arising from the cervical segment of ICA at C2-C3 vertebral level coursing posteriorly and superiorly to enter intracranially and continuing as basilar artery. Bilateral subclavian artery injection showed hypoplastic bilateral vertebral artery (VA).