Rd. Zafonte et al., MOVING BULLET SYNDROME - A COMPLICATION OF PENETRATING HEAD-INJURY, Archives of physical medicine and rehabilitation, 79(11), 1998, pp. 1469-1472
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.