Spontaneous Movement of Bullets in the Interhemispheric Region

Abstract

Gunshot wounds to the head are usually mortal injuries. Their frequency has been increasing in the last years because of increasing crime and war rates. Penetrating craniocerebral injury in children and adolescents at the age of 17 or under is an increasing cause of emergent neurosurgical admissions to major metropolitan medical centers. I report a patient in whom a bullet in the brain moved from the interhemispheric region to 1 cm to the left of the inner occipital protuberance and midline. The patient recovered from surgery uneventfully. He was followed up for 4 years without neurodeficits. Spontaneous movement of bullets within the brain has been reported sporadically. The removal of intracerebral bullets is obviously warranted in patients undergoing craniotomy or craniectomy for debridement or evacuation of intracerebral clots or bone fragments if the metallic fragment is in proximity to the operative site. Before surgical removal of any intracerebral bullet, it is recommended that an intraoperative plain skull X-ray be obtained after final positioning of the head.

A Migrating Retained Intracranial Bullet Presenting with Hydrocephalus and Alterations of Consciousness: A Case Report and Literature Review

“…There are several reports in the literature regarding the migrating retained intracranial bullets (1)(2)(3)(4). All these reports indicate a tendency for intracranial bullets to migrate through the ventricular system, cisternae, and cerebral hemispheres (5)(6)(7)(8).…”

“…Higher gravidity of the bullet in comparison to the brain tissue, pulsatile force of the brain and cerebrospinal fluid (CSF), and softening of the brain tissue through fragment trajectory are among the most common mechanisms (9). The presence of a bullet or metal missile fragment as a foreign body is associated with several complications, such as meningitis, abscess formation, CSF fistula, epilepsy, hematoma, hydrocephalus, altered level of consciousness, and confusion (2,3,5,10,11).…”

Intracranial Ricocheting of Bullet from Anterior Clinoid Process

“…[1][2][3] Their frequency has been increasing in the last years because of increasing crime, armed struggle between political parties and war rates. 1 We present a unique case of intracranial ricocheting of bullet without neurological deficits and discuss the mechanism behind the spontaneous migration of the bullet in the brain tissue. There are only few literature reports of spontaneous migration of a bullet within the brain.…”

The role of strict patient-positioning during nursing in the management of intracerebral migration of gravitational bullet injury

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The intracranial migration of bullet was described in literature since Cushing time and the First World War [1]. The literature is still away from delivering a clear guideline and constitutes more of case reports rather than comprehensive well-designed studies [2][3][4][5][6][7][8][9][10][11][12][13], this mostly due to the variability and diversity in the presentation and management of such cases. The migration of bullet can be a sequel of any type of penetrating injury to the skull [14].

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