Child's Nervous System

, Volume 32, Issue 7, pp 1317–1320

Shotgun pellet embolization to the posterior cerebral artery

  • Michael M. McDowell
  • Xiao Zhu
  • Steven Johnson
  • Christopher Deibert
  • Brian Jankowitz
  • Ian F. Pollack
Case Report

DOI: 10.1007/s00381-015-3000-3

Cite this article as:
McDowell, M.M., Zhu, X., Johnson, S. et al. Childs Nerv Syst (2016) 32: 1317. doi:10.1007/s00381-015-3000-3

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.

Keywords

Projectile Embolism Pediatric Trauma Pellet Bullet 

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Michael M. McDowell
    • 1
  • Xiao Zhu
    • 1
  • Steven Johnson
    • 1
  • Christopher Deibert
    • 1
  • Brian Jankowitz
    • 1
  • Ian F. Pollack
    • 1
    • 2
  1. 1.Department of Neurological SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Children’s Hospital of PittsburghPittsburghUSA

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