Michael M McDowell1, Xiao Zhu2, Steven Johnson2, Christopher Deibert2, Brian Jankowitz2, Ian F Pollack2,3. 1. Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, B-400, Pittsburgh, PA, 15213, USA. Mcdowellmm2@upmc.edu. 2. Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, B-400, Pittsburgh, PA, 15213, USA. 3. Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
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.
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.
Authors: Carlos Vaquero-Puerta; Enrique M San Norberto; Borja Merino; José A González-Fajardo; James Taylor Journal: J Vasc Surg Date: 2011-10-01 Impact factor: 4.268