Cerebral Embolism After Gunshot Wounds
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چکیده
A 22-year-old man presented with a self-inflicted gunshot wound to the left neck. The rifle used was a .22 caliber filled with multiple small bird-shot pellets . Medical history was noncontributory. Physical examination showed an 8-mm diameter entrance wound in the left posterior oral cavity without active bleeding. Powder burns were present. No exit wound was identified. Except for mild left neck swelling, the physical examination was unremarkable. The carotid artery pulses were 2+ and symmetric. No bruits were audible. No focal motor or sensory deficits were discovered on physical examination . Cervical spine films showed scattered pellets throughout the left upper neck, and skull films revealed one intracranial pellet without skull fracture. A selective left internal carotid angiogram was performed and showed a minimally narrowed internal carotid artery without evidence of contrast extravasation (Fig. 1 A). Head views showed one pellet within a left middle cerebral artery branch (Figs. 1 B and 1 C). Three days later, a non contrast CT scan of the head confirmed an intracranial location of the fragment with an intact calvaria (Fig . 1 D). No evidence of infarct, hemorrhage, or mass effect was seen. On CT, an additional small second fragment not seen on plain films or angiograms was identified.
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