Conservative management of intraventricular migrating intracranial bullet

Abstract

Background. The high mortality rate of a cranial bullet injury, the catastrophic damage of vital tissue, and the frequency of gunshot accidents made managing such cases highly effortful in neurosurgical trauma centres. One category of these injuries is the gravitational bullet injury, in which the bullet's movement depends on gravity after losing its kinetic energy. This paper aims to describe the conservative treatment plan we applied for a patient who suffered an intracranial gravitational bullet injury. Case description. The patient presented with a cranial bullet injury that migrated caudally to his lateral ventricle. This unapproachable location of the bullet made the surgical intervention undoable. Therefore, after the implication of resuscitative management, the patient went under heavy observation with a suitable follow-up plan. The patient's short-term outcome was excellent, and his Glasgow coma scale was 15 at the discharge. Conclusion. Conservative management in a gravitational bullet is one of the possible methods to reach the best outcome in non-operable patients. Such measures are highlighted in this case, even when a complication like a bullet migration may occur.

Keywords

• gravitational bullet injury
• conservative management
• migrating intracranial bullet injury