key: cord-1017922-uqxltf1m
authors: Golomb, Meredith R.; Tejada, Juan G.; Ducis, Katrina A.; Martinez, Mesha L.
title: Acute and delayed cerebrovascular injury from gunshot to the head in a 12-year-old child during the COVID-19 pandemic
date: 2022-02-11
journal: Pediatr Neurol
DOI: 10.1016/j.pediatrneurol.2022.02.001
sha: ea9d81d718092ec7f464d9f3b3b2b371ec083c29
doc_id: 1017922
cord_uid: uqxltf1m

nan

To the editor:

The risk of gun injuries in American children almost doubled in the first 6 months of the COVID-19 pandemic 1 . Gun violence overall increased 30% the first year of the pandemic 2 .

Gunshot injuries to the head and neck can cause neurovascular injury and stroke, but management of ballistic cerebrovascular injury is not well-described in the pediatric stroke literature. We present a child shot during the pandemic who had significant acute and delayed cerebrovascular injury, but no stroke, likely due to medical mangement.

In December 2020, a 12-year-old boy was shot in the face by his sister's friend, who was playing with a loaded gun. The boy yelled he was shot; his mother called 911. He was intubated in the emergency room (ER). Computed tomography (CT) and CT angiography (CTA) revealed He was admitted to the intensive care unit. Aspirin 81mg/day was started for stroke prevention due to concern for ICA dissections. He received prophylactic antibiotics and pain control. He was extubated the next day, and discharged home 3 days after admission, with no Both vascular dissection and vasospam are known complications of gunshot injury to the head and neck in adults 3 , but rarely reported in children 4, 5 . Vasospasm may occur days after initial injury, usually triggered by subarachnoid hemorrhage (SAH). Small amounts of SAH may not be visible on intracranial imaging. We did not see SAH in our patient, but suspect it was present due to bullet injury. Dissection may also become more obvious with time after injury due to edema and hemorrhage into the vascular wall. It is possible that some of the posterior circulation injury was delayed presentation of dissection.

SSentongo et al 2 pointed out that the increase in gun violence during the pandemic may represent more of a risk to children's health than COVID itself. Reasons proposed for the increase in gun violence during the pandemic included increased stress levels and increased gun sales.

Our patient's outcome was surprisingly good, with no progression to infarction despite significant anterior and posterior circulation vascular injury. We believe his treatment with aspirin, hydration, norepinephrine, and a calcium channel blocker (verapamil) all contributed to the prevention of stroke in this patient. We suggest early vascular imaging and repeat vascular 

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