Cranio-thoracic bullet migration over a period of 27 years: case report

We report the case of a 36 year old woman that was hurt in the head with a lost bullet while walking through the street when she was 9 years old. On admission, the patient was fully conscious with no neurological deficits. Skull radiography showed the intracranial bullet but she was dispatched after 24 hours of observation without neurological deterioration. Six months later she suddenly presented quadriplegia and after one year of rehabilitation she recovered the mobility and strength in all her limbs. 25 years latter she began with thoracic pain (dermatomal sensory changes), constipation, paresthesias and weakness in the lower extremities; the X-Ray showed a bullet caliber 9 mm in the thoracic canal at T4 level. The bullet was removed via posterior laminectomy and dorsal midline mielotomy. 12 hours after surgery, the patient presented signs of medullar shock. The post-operatory MRI showed the trajectory of the bullet through the brain to the spinal cord in FLAIR, and spinal cord edema as well. The patient received steroids as treatment for the spinal cord edema, and with the help of rehabilitation she recovered movement in the lower extremities 30 days after the surgery.