Spontaneous Intracranial Bullet Migration: A Complication of Penetrating Cranial Gunshot Wound: Case Report and Review of the Literature

Spontaneous migration of retained bullets in the brain is a recognized rare complication of penetrating cranial gunshot wounds to the brain. The authors report one rare case in a 55-year old male patient who presented with a penetrating cranial gunshot wound and a retained bullet. He had a dense right hemiplegia and expressive aphasia on admission. Skull x-ray confirmed the retained intracranial bullet, which on CT scan was located at the left parietal-occipital region. He was managed conservatively. A repeat CT scan 17 days post injury showed spontaneous migration of the bullet to the left occipital pole adjacent to the superior sagittal sinus and near to the Torcula Herophili. He had a remarkable improvement of his right sided weakness but had severe receptive and expressive language deficits. This case highlights the need to watch out for the occurrence of spontaneous migration of intracranial bullets after a penetrating cranial gunshot wound and when detected management decisions should be individualized.