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Asymptomatic intrapetrous carotid artery stenosis after a gunshot to the head

An 11-year-old girl was accidently hit by a gunshot. Immediately after the injury, she developed a transient headache, vomiting, and a reduced level of consciousness. The neurologic examination was otherwise normal. A cerebral CT angiography showed the parenchymal course of the bullet from the right parietal region to the right petrous apex, without bleeding. The cervical, intrapetrous, and intracavernous segments of the internal carotid artery showed a residual concentric lumen of 1–2 mm, indicating a plausible mechanism of posttraumatic dissection, secondary to the energy transference from the bullet to surrounding structures (figure). After 6 months, the patient was neurologically normal. This case shows an exceptional, but potentially lethal event.1,2 Three-dimensional neuroradiologic rendering was helpful in evaluating the neurovascular relationships of the bullet (video 1).