Bullet in the Brain

While evaluating this 26-year-old man for suspected sinusitis, skull films revealed the fragments of a 32-caliber gunshot embedded in his brain. The anteroposterior and lateral radiographs show three metallic bullet fragments; the largest remnant is on the left side of the occipitoparietal region. The patient reported being shot at age 11 but denied any residual neurologic signs.

Drs Gamil Kostandy, Hesham Taha, Salama Salama, Maged Ghaly, Bruce Sosler, Hani Ashamalla, and A. Veloudios of Brooklyn, NY, report that it is not uncommon to see these foreign bodies in the brain tissue with no delayed symptoms or signs. Besides the wide range of neurologic damage that might occur depending on the site and structure impacted by the gunshot, common complications of this injury include lead poisoning, arthropathy, and spontaneous movement in the brain tissue secondary to the influence of cerebral softening. Depending on the ballistic and anatomic parameters, the intracranial sequelae vary from no residual effects to severe neurologic damage.

The radiographs disclosed no sinus opacity. The doctors add that they recommend continued observation of the patient.