Spontaneous migration of an intracranial bullet to the cervical spinal canal causing Lhermitte's sign

Arasıl, Ertekin; Tascioglu, Ali O.

doi:10.3171/jns.1982.56.1.0158

Cited by 55 publications

(19 citation statements)

References 10 publications

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“…However, intracranial migration of bullets has been described in the literature [10, 11, 12, 13]and can occur in the intervening period between localization and surgical exploration [13]. In addition, the procedure is time-consuming and slightly more cumbersome.…”

Section: Discussionmentioning

confidence: 99%

Endoscopically Assisted Retrieval of an Intracranial Air Gun Pellet

Mohanty¹,

Manwaring²

2002

Pediatr Neurosurg

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Intracranial missile injuries often lodge in deep and inaccessible areas of the brain and are sometimes difficult to remove. Many such missiles are left behind for the fear of surgical morbidity. The authors report the successful removal of a deep-seated intracranial air gun pellet with the aid of an endoscope. A 4-year-old child was admitted after being injured by an air gun pellet in the left forehead. He had no neurological deficits. Cranial CT scan revealed evidence of a pellet lodged in the left frontal region with small bone fragments driven into the adjacent parenchyma. The patient underwent a left frontal craniotomy around the entry wound and debridement of the bone fragments. The track was explored carefully with the aid of a rigid fiberscope and the pellet was identified and removed easily. Postoperatively, the patient had an uneventful recovery. Endoscopic retrieval of the projectile by following the track may be considered a reasonable alternative in suitable cases. This might be useful in retrieving deep-seated missiles.

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Section: Discussionmentioning

confidence: 99%

Endoscopically Assisted Retrieval of an Intracranial Air Gun Pellet

Mohanty¹,

Manwaring²

2002

Pediatr Neurosurg

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“…The time course for migration ranges from 2 days to 3 months. [2,7,10] The course of a ricochet bullet is different from migration movement of a retained bullet. A ricochet bullet changes its direction after hitting the wall of the cranium or spinal canal, whereas retained bullet migration may be affected by several factors, such as gravitational factors.…”

Section: Discussionmentioning

confidence: 99%

“…[3] Gravitational force acting on the bullet, which is denser than the surrounding medium, has been suggested as a cause for migration caudally by the effect of gravity related to the position of the body, especially in the absence of significant cranial swelling. [7,10] Castillo-Rangel and Salvati [2,12] suggested that the ventricular system provides transport of the bullet from one area of the brain to another. Cerebrospinal fluid (CSF) flow and pulsation will facilitate the bullet's movement within the ventricle.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous migration of a retained bullet within the brain: a case report

Arslan

Eşeoğlu²,

Güdü³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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Başın kurşun yaralanmaları genellikle ölümcüldür ve beyin içinde kalan kurşunun kendiliğinden hareketi nadir bir durumdur. Bu olgu sunumunda, 23 yaşındaki erkek hastanın beyninde kendiliğinden hareket eden kurşun sunuldu. Beyin bilgisayarlı tomogafisi (BT) kurşunun sol parietal bölgede derin yerleşimli olduğunu gösterdi. Hastanın bilinci açıktı ve sağ homonium hemianopsi vardı. Kurşun, hayati yapılara yakın ve derin yerleşimliydi. Bu yüzden, cerrahi girişim düşünülmedi. İki ay sonra çekilen kontrol BT'sinde kurşunun yerçekimi etkisi ile kaudale ve posteriyora doğru yer değiştirdiği görüldü. Beyin içinde kalan kurşunun tedavisi tartışmalıdır. Derinde yerleşen kurşunu çıkarmak ek nörolojik hasara neden olabileceği gibi kalan kurşunun hareketi de hayati yapıların zarar görmesine neden olabilir.Sonuç olarak, ek nörolojik defisite neden olmayacak kolay ulaşılabilir kurşunların çıkarılmasını öneriyoruz.Anahtar Sözcükler: Beyin yaralanması; kurşun; spontan hareket.Gunshot injury to the head is usually mortal, and spontaneous migration of a retained bullet is rare. We report the case of a 23-year-old man with a spontaneously migrated bullet within the brain. Cranial computerized tomography (CT) indicated that the bullet was lodged deeply in the left parietal region. The patient was conscious and had right homonymous hemianopsia. The bullet was close to the vital structures and deep-seated; therefore, surgical intervention was not considered. Two months after the injury, repeat CT revealed that the bullet had migrated posteriorly and caudally due to gravitational factors. Management of the retained bullet was controversial. Removal of a deep-seated bullet may cause additional neurological deficit, but migration of a retained bullet may cause damage to vital structures, producing significant neurological damage. We proposed that the bullet in the brain should be removed if it could be reasonably accessed without causing additional neurological damage.

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“…Migration of bullets can occur under four types of conditions 7) : Bullets in the ventricular system, or in the subarachnoid space, which are free to move 1,5,6,8) ; fragments in necrotic liquefied brain tissue, which move only to a limited extent in this cavity 2) ; projectiles in a trajectory of destructive brain tissue, which can move in the reverse direction; and the slow sinking of intact heavy bullets by gravity. 5,7,10) The third type must be unlikely, because brain swelling may collapse the bullet trajectory.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Migration of a Bullet in the Cerebellum. Case Report.

Fujimoto

Cabrera

Pahl

et al. 2001

Neurol. Med. Chir.(Tokyo)

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A 15-year-old boy presented with a gunshot wound in the left cerebellar hemisphere. He was confused and left cerebellar signs were noted. The patient underwent the first surgery for debridement of the entry wound in the left parietal region and second surgery to remove the bullet. However, the bullet could not be located via a left unilateral suboccipital craniectomy in the park bench position, because it had migrated to the opposite side due to the effects of gravity in just a few hours. Skull radiography obtained just before the third surgery showed that the bullet had returned to the left side, and it was removed easily via the previous craniectomy in the sitting position. The clinical course suggests that in removing a bullet, skull radiography or computed tomography should be obtained just before surgery, or even intraoperatively, and that those findings should be the basis for the surgical procedure and operative position.

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Spontaneous migration of an intracranial bullet to the cervical spinal canal causing Lhermitte's sign

Cited by 55 publications

References 10 publications

Endoscopically Assisted Retrieval of an Intracranial Air Gun Pellet

Endoscopically Assisted Retrieval of an Intracranial Air Gun Pellet

Spontaneous migration of a retained bullet within the brain: a case report

Spontaneous Migration of a Bullet in the Cerebellum. Case Report.

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