High-velocity bullet causing indirect trauma to the brain and symptomatic epilepsy

Epilepsy is a frequent consequence after missile wounds of the brain. So far, no epilepsy cases with missile injury have been described in which epilepsy ensued without direct missile injury of the brain. During World War II, in 1941, our patient, then a soldier in the German army, suffered a bullet injury to the head; the bullet entered the cranium at the base of the nose. The bullet penetrated the head below the base of the cranium and remained stuck subcutaneously left of the second cervical vertebra. In the field hospital the patient suffered from focal seizures. The fits ceased within a few years under medication. In 1990 the seizures returned, this time with secondary generalization. In our case, a 7.62-mm bullet from the Russian Tokarev military pistol was used, which is known to have the highest muzzle velocity of all handguns available (> 500 m per second). We suspect that the so-called hydrodynamic effect of this high-velocity bullet caused an indirect trauma to the brain. This case shows that symptomatic epilepsy can occur after a penetrating head injury, without direct injury to brain tissue by a missile. High-velocity missiles are increasingly used in armed conflicts around the world. In light of the case reported here, in which the initial epilepsy was exacerbated more than 50 years after the wounding event, physicians must consider this possibility when dealing with veterans presenting with seizures. This case also has implications for the payment of benefits and pensions.