[Shotgun pellet embolus in the cerebral circulation via the internal carotid artery in the neck; a case report].

A 57-year-old hunter was shot accidentally and admitted to our hospital without any neurological deficits. Plain X-ray films of the neck revealed the presence of several shotgun pellets, one of which was thought to be in the vicinity of the right internal carotid artery at the C1 level. One week later, while surgical removal of pellets was being performed under fluoroscopic control, the pellet entered into the lumen of the artery and migrated to the intracranial vessels. Right carotid angiogram revealed that the pellet occluded in the right angular artery about 1.5cm distal from its outlet. Although embolectomy was performed, we could not get a patency of the vessel. CT scan taken 3 days after operation showed the occurrence of massive cerebral edema. Angiogram taken 2 weeks after confirmed occlusion of the vessel. The patient was discharged with left lower quadrantanopsia one month after the operation. In the literature, 20 similar cases have been hitherto reported and briefly reviewed. Of these 20, 6 cases died of cerebral infarction. We believe that embolectomy is warranted as soon as possible when patients show a condition building up to a stroke.