Sinking bullet syndrome: A unique case of transhemispheric migration

Leone, Augusto; Parsons, Andrew D.; Willis, Sean; Moawad, Stephanie A.; Rahme, Ralph

doi:10.1016/j.clineuro.2021.106607

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…Intracranial RBFs can cause a multitude of complications. Outside of the acute penetrating injury from the initial GSW, feared complications include abscess formation, both subacute 33,34 and delayed, 35,36 and migration of fragments [37][38][39][40] that can lead to new deficits. Additionally, patients with GSWs to the head almost ubiquitously suffer neurological sequelae from their initial injury, which may mask symptoms of lead toxicity.…”

Section: Discussionmentioning

confidence: 99%

Lead toxicity due to retained intracranial bullet fragments: illustrative case

Aaronson

Awad

Hedayat

2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Lead toxicity (plumbism) secondary to retained lead bullet fragments is a rare complication in patients with gunshot wounds. To the authors’ knowledge, there has been no definitive case reported of lead toxicity due to retained intracranial bullet fragments. OBSERVATIONS The authors reported the case of a 23-year-old man who presented after being found down. Computed tomography scanning of the head revealed bullet fragments within the calvaria adjacent to the left transverse sinus. During follow-up, he developed symptoms of plumbism with paresthesias in his bilateral hands and thighs, abdominal cramping, labile mood, and intermittent psychosis. Plumbism was confirmed with sequentially elevated blood lead levels (BLLs). The patient opted for surgical removal of the bullet fragments, which led to reduction in BLLs and resolution of his symptoms. LESSONS Although rare, lead toxicity from retained intracranial bullet fragments should be considered in patients who have suffered a gunshot wound to the head and have symptoms of lead toxicity with elevated BLLs. For safe and accessible intracranial bullet fragments in patients with plumbism, surgical intervention may be indicated.

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Section: Discussionmentioning

confidence: 99%

Lead toxicity due to retained intracranial bullet fragments: illustrative case

Aaronson

Awad

Hedayat

2022

Journal of Neurosurgery: Case Lessons

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“…Another complication of PBI is delayed migration of the projectile, which was reported in 4.2% of cases in the largest reported series of 213 patients who suffered a gunshot wound to the head. 6 – 18 The timing of migration of intracranial bullets is quite variable and has been reported to occur within hours to days to as long as 4–5 years after injury. Most migrating projectiles are bullets, possibly related to their shape.…”

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confidence: 99%

Wartime penetrating skull base trauma with unpredictable internal fragment ricochet and migration: illustrative case

Sirko,

Valadka,

Armonda

et al. 2024

J Cosmet Laser Ther

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BACKGROUND Transnasal transsphenoidal penetrating craniocerebral injury is very rare even in wartime. Cases with good outcomes are even less common. OBSERVATIONS A 20-year-old male sustained multiple fragment wounds to his head and face from a landmine explosion. One metal fragment entered his right nostril, traversed the nasal septum and anterior sphenoid sinus, and ricocheted superiorly off the clivus. The fragment then traveled almost to the surface of the left parietal lobe. Subsequently, under its own weight, it migrated back down its original track. The patient suffered cerebrospinal fluid rhinorrhea, pneumocephalus, and right-sided hemiparesis. Digital subtraction angiography was followed by microscopic transnasal skull base reconstruction supplemented by external lumbar drainage. Follow-up brain computed tomogrpahy showed further metallic fragment migration through the ventricular system. The fragment was removed through a transcortical approach. The patient’s neurological examination and brain magnetic resonance imaging results demonstrated good recovery. LESSONS The absence of external signs of deep injuries does not exclude the presence of a penetrating craniocerebral injury. Metal fragments may undergo ricochet and internal migration in both the brain parenchyma and the ventricular system. Timely diagnosis including three-dimensional reconstruction of a projectile’s trajectory may facilitate appropriate surgical planning in complex cases. Intraventricular fragment migration may necessitate microsurgical removal. https://thejns.org/doi/10.3171/CASE24128

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