Persistent hypoglossal artery (PHA) which is a persistent carotid-basilar anastomosis is a rare vascular anomaly. It is usually found incidentally. We present a case of persistent left hypoglossal artery associated with absent bilateral vertebral arteries in a 62 year male patient presenting with vertigo and giddiness for 1 month. This finding was only incidental. There were no associated findings in this patient.