Ischaemic Stroke Caused by a Gunshot Wound to the Chest

• Published in: EJVES vascular forum Vol. 47; pp. 97 - 100
• Main Authors: Helán, Martin, Ráb, Martin, Šrámek, Vladimír, Vaníček, Jiří, Staffa, Robert, Volný, Ondřej, Suk, Pavel
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-01-2020; Elsevier
• Subjects: Bullet embolisation; Case Report; Decompressive craniectomy; Firearm injury; Stroke; Stroke; Firearm injury; Decompressive craniectomy; Bullet embolisation
• ISSN: 2666-688X; 2666-688X
• DOI: 10.1016/j.ejvssr.2019.12.004

Pneumatic weapons rarely cause severe trauma. However, pellet embolisation can cause severe and unexpected injuries.
This is the case study of a 32 year old man, who was shot in the chest with a pneumatic rifle. Initially, urgent damage control surgery was performed to resolve pneumothorax and pericardial tamponade, but no projectile was found. Subsequent atypical symptomatology led to more extensive imaging that found a pellet embolised into the right carotid artery, thrombosis of the middle cerebral artery, and development of a large right hemispheric ischaemic area. After an unsuccessful endovascular intervention, the projectile was removed during an open surgical procedure. The right hemisphere oedema required decompressive hemicraniectomy, but long term intensive care and physiotherapy resulted in a satisfactory recovery with moderate neurological sequelae.
An unusual clinical presentation in combination with an absent exit wound might be symptomatic of projectile embolisation and should lead to a search for it. When the projectile position is convenient, surgical removal is the treatment of choice while an endovascular approach should be reserved for inaccessible locations or asymptomatic cases.
•Projectile embolisation can lead to severe and unexpected pathologies.•Unusual clinical signs and an absent exit wound are suspicious of embolisation.•For symptomatic emboli, urgent projectile removal is necessary.•Surgical rather than endovascular removal is preferred for symptomatic emboli.