Shotgun Pellet Embolus to the Middle Cerebral Artery: Case Report

David, Whitney; Odeh, Yousef; Mittal, Vijay K.

doi:10.1097/01.ta.0000032247.03438.78

Cited by 6 publications

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“…4 Although many times the site of penetration into the arterial system was not clearly identified, in the cases of neck injury 2-4,6-11 the carotid artery was usually the point of penetration, although one case of vertebral artery was described. 4 When the chest has been involved, 1,2,4,5,[11][12][13] the metallic foreign body is dislodged into the intracranial circulation through the aorta, supra-aortic vessels, left ventricle, or even the pulmonary veins. In these cases, the hemispheric site of embolization was primarily influenced by the anatomy of the arterial system.…”

Section: Discussionmentioning

confidence: 99%

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Shotgun wound and pellet embolism to the intracranial carotid artery

Vaquero-Puerta

Norberto

Merino

et al. 2012

Journal of Vascular Surgery

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Missile embolism into the cerebral circulation is a very unusual complication of shotgun wounds to the chest or neck. We report a case of an 11-year-old boy who sustained an air gunshot wound and pellet embolism to the intracranial carotid artery. The cerebral artery pellet embolus resulted in contralateral hemiplegia. The patient was successfully treated by emergency flow reversal and embolectomy. Because this injury is extremely rare, the literature is reviewed, and several principles are suggested to improve the management.

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Section: Discussionmentioning

confidence: 99%

“…Indeed, the missile was left in place in 30 cases, four (13.4%) asymptomatic patients, 2,4,6 and 26 (86.6%) with some neurologic deficit. 1,2,4,5,7,[10][11][12] So, in opposition to the peripheral vessels, the intracranial pellets usually are well tolerated if the patient survives the injury.…”

Section: Discussionmentioning

confidence: 99%

Shotgun wound and pellet embolism to the intracranial carotid artery

Vaquero-Puerta

Norberto

Merino

et al. 2012

Journal of Vascular Surgery

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Pellet in the stomach: Where did it come from?

Yildiz

Sulu

2012

Journal of Acute Disease

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Open Surgery for Extraction of an Embolized Pellet in the Middle Cerebral Artery From a Shotgun Injury

Monterey

Kerr

Dannenbaum

et al. 2018

ONSURG

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BACKGROUND AND IMPORTANCE Embolization of shotgun pellet from the peripheral vasculature to the cerebral vessels has been a known phenomenon that has been reported previously in the literature. However, there is no consensus on clinical indications for intervention, best modality of intervention or management upon leaving the hospital. We describe a case of a shotgun pellet in the neck that embolized to the middle cerebral artery that was treated with open surgery. Discussed is the initial management on presentation, timing of intervention from surgery and detailed surgical technique. CLINICAL PRESENTATION A 20-yr-old man presented after being shot at close range with a shotgun. He was neurologically intact on exam. Initial screening computed tomography (CT) of the brain noted a shotgun pellet in the region of the sylvian fissure without intracranial hemorrhage. Computed tomography angiography again displayed pellet in the vicinity of the left middle cerebral artery. He was emergently taken for an awake cerebral angiogram and subsequent surgical extraction of the shotgun pellet. CONCLUSION Missile embolization of a bullet fragment to the intracranial vasculature is rare and requires difficult decisions regarding management. Critical factors that are to be considered prior to treatment include neurological clinical presentation, timing of the trauma, and anatomic location of injury. Patients who are without neurological deficit that display compromised blood flow require immediate cerebral angiogram followed by surgical intervention depending on location.

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Shotgun Pellet Embolus to the Middle Cerebral Artery: Case Report

Cited by 6 publications

References 0 publications

Shotgun wound and pellet embolism to the intracranial carotid artery

Shotgun wound and pellet embolism to the intracranial carotid artery

Pellet in the stomach: Where did it come from?

Open Surgery for Extraction of an Embolized Pellet in the Middle Cerebral Artery From a Shotgun Injury

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