MOVING BULLET SYNDROME - A COMPLICATION OF PENETRATING HEAD-INJURY

Penetrating injuries, by definition, result in retained bullets or fra gments. Usually, these fragments are removed surgically during wound d ebridement. Occasionally, the position of the bullet may preclude remo val if it is thought that surgery could exacerbate neurologic damage. Complications from retained fragments are uncommon. One rare complicat ion is the spontaneous migration of the fragment. Two cases of spontan eous migration of retained bullets are presented. In both cases neurol ogic deterioration was noted and computed tomographic imaging was diag nostic. In one case, this complication delayed transfer from the acute care hospital to rehabilitation. In the other case, the migrating bul let was removed during the inpatient rehabilitation stay. Each person improved neurologically after the migrating bullet fragment was remove d. Additionally, functional progress was marked in both persons and sy mptomatic relief noted. Rehabilitation physicians caring for survivors of penetrating brain injuries need to be aware of this potentially de vastating phenomenon. (C) 1998 by the American Congress of Rehabilitat ion Medicine and the American Academy of Physical Medicine and Rehabil itation.