Chronic penetrating traumatic brain injury - intracranial bullet

Case contributed by Dr Mahmoud Ibrahim Mekhaimar

Presentation

Headache and dysarthria

Patient Data

Age: 25 years
Gender: Male

The inlet of a bullet is seen in the left parietal bone with few related intra-axial bone fragments. The bullet is settled anteriorly in the inter-hemispheric fissure.

No outlet noted. 

A left frontoparietal linear track of CSF like density is seen along the bullet course, likely representing encephalomalacia. 

Subsequent ex-vacuo dilatation of the left lateral ventricle is seen. 

Few small radiodense objects/bone fragments are seen along the bullet course as well.

Paranasal sinus opacification noted. 

Case Discussion

On further inquiry, the patient claimed that there was an old history of a bullet injury, after which he developed these findings. 

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