Abstract
Introduction
Projectile embolization to the cerebral vasculature and is almost exclusively seen in the anterior circulation due to the greater diameter and flow of the internal carotid arteries. In children, this phenomenon is ever rarer.
Methods
We present a case of a 9-year-old boy who suffered from a shotgun blast to the thorax and abdomen. He was subsequently found to have a pellet that had presumably traveled from either the left ventricle or directly via the subclavian artery to the vertebrobasilar system to become lodged in the P3 segment of his posterior cerebral artery.
Results
The patient developed a small occipital infarct with a corresponding right superior quadrantanopsia. He was managed as an inpatient non-operatively with a heparin drip and was placed on long-term low-dose aspirin on discharge. The patient recovered well from his injury and remains neurologically stable 2 years after the initial injury. Interval imaging demonstrated that the pellet remains stable in its position.
Discussion
To our knowledge, this represents the first non-fatal missile embolus to the posterior cerebral artery in a pediatric patient. Patients with minimal symptoms may benefit from conservative management given the inherent risks of embolectomy.
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This report was generated using the ethical standards of the University of Pittsburgh Medical Center.
Intent to publish was indicated with full disclosure to the family and with consent from the family for publication of this report.
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None of the authors have conflicts of interest to disclose.
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Michael M. McDowell and Xiao Zhu contributed equally to this work.
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McDowell, M.M., Zhu, X., Johnson, S. et al. Shotgun pellet embolization to the posterior cerebral artery. Childs Nerv Syst 32, 1317–1320 (2016). https://doi.org/10.1007/s00381-015-3000-3
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DOI: https://doi.org/10.1007/s00381-015-3000-3