title: Shotgun pellet embolization to the posterior cerebral artery.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, B-400, Pittsburgh, PA, 15213, USA. Mcdowellmm2@upmc.edu.
authors.forename: Michael M
authors.initials: MM
authors.lastname: McDowell
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, B-400, Pittsburgh, PA, 15213, USA.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, B-400, Pittsburgh, PA, 15213, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Johnson
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, B-400, Pittsburgh, PA, 15213, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Deibert
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, B-400, Pittsburgh, PA, 15213, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Jankowitz
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, B-400, Pittsburgh, PA, 15213, USA.|Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Ian F
authors.initials: IF
authors.lastname: Pollack
mesh_terms: D002648:Child; D004617:Embolism / Q000209:etiology* / Q000601:surgery*; D005548:Foreign-Body Migration / Q000601:surgery*; D006801:Humans; D008297:Male; D020769:Posterior Cerebral Artery / Q000503:physiopathology*; D014948:Wounds, Gunshot / Q000150:complications*
keywords: Bullet; Embolism; Pediatric; Pellet; Projectile; Trauma