Ischemic stroke after pellet embolization

A 9-year-old boy was shot with a pellet shotgun and developed a visual field deficit. Head CT revealed a pellet in the left ambien cistern, in the left posterior cerebral artery on catheter angiography (figure). Chest fluoroscopy revealed multiple thoracic pellets, including a mobile cardiac pellet (video on the Neurology (R) Web site at [GRAPHICS] ). There was no clear cardiac injury, patent foramen ovale, or skull penetration. Arterial embolization of a pellet from the chest to the intracranial vasculature likely caused a stroke.(1,2) We considered arteriotomy, endovascular retrieval, and medical therapy. The established infarct, clinical stability, and flow distal to the pellet argued for conservative treatment; the visual field deficit was unchanged at 1-month follow-up visit.