Child's Nervous System

, Volume 32, Issue 7, pp 1317–1320 | Cite as

Shotgun pellet embolization to the posterior cerebral artery

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



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.


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.


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.


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.


Projectile Embolism Pediatric Trauma Pellet Bullet 


  1. 1.
    Mattox KL, Beall AC Jr, Ennix CL, DeBakey ME (1979) Intravascular migratory bullets. Am J Surg 137:192–195CrossRefPubMedGoogle Scholar
  2. 2.
    Rich NM, Collins GJ Jr, Andersen CA, McDonald PT, Kozloff L, Ricotta JJ (1978) Missile emboli. J Trauma 18:236–239CrossRefPubMedGoogle Scholar
  3. 3.
    Vaquero-Puerta C, San Norberto EM, Merino B, Gonzalez-Fajardo JA, Taylor J (2012) Shotgun wound and pellet embolism to the intracranial carotid artery. J Vasc Surg 55:535–537CrossRefPubMedGoogle Scholar
  4. 4.
    da Costa LB, Wallace MC, Montanera W (2006) Shotgun pellet embolization to the posterior cerebral circulation. AJNR Am J Neuroradiol 27:261–263PubMedGoogle Scholar
  5. 5.
    Patel KR, Cortes LE, Semel L, Sharma PV, Clauss RH (1989) Bullet embolism. J Cardiovasc Surg 30:584–590Google Scholar
  6. 6.
    Corbett H, Paulsen EK, Smith RS, Carman CG (2003) Paradoxical bullet embolus from the vena cava: a case report. J Trauma 55:979–981CrossRefPubMedGoogle Scholar
  7. 7.
    Schurr M, McCord S, Croce M (1996) Paradoxical bullet embolism: case report and literature review. J Trauma 40:1034–1036CrossRefPubMedGoogle Scholar
  8. 8.
    Hungerford GD, Reines HD, Powers JM, Otherson HB Jr (1981) Shotgun pellet embolus to the posterior cerebral artery. AJNR Am J Neuroradiol 2:185–186PubMedGoogle Scholar
  9. 9.
    Jones BV, Tomsick TA (1995) Shotgun pellet embolus to the basilar artery. AJR Am J Roentgenol 165:744CrossRefPubMedGoogle Scholar
  10. 10.
    Timpone VM, Jesinger RA, Johnson T, Palka P (2009) IED fragment embolism to left posterior cerebral artery. Military medicine 174: iv-vGoogle Scholar

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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