A Migrating Retained Intracranial Bullet Presenting with Hydrocephalus and Alterations of Consciousness: A Case Report and Literature Review

Migrating intracranial bullets are a dilemma to neurosurgeons, as their management is challenging, and the removal process is associated with high mortality and morbidity rates. They are also associated with alterations in consciousness and focal neurological defects. We herein report a 40-year-old man with a retained intracranial AK-47 bullet for 22 years, admitted to our emergency department with decreased level of consciousness. He was diagnosed with meningitis and obstructive hydrocephalus, given the pressure effect of the bullet over the aqueduct of Sylvius. He underwent placement of external ventricular drainage (EVD) and received broad-spectrum antibiotics. However, he passed away due to complications of meningitis. Postmortem examination revealed that the bullet had entered the anterior perforated substance from ethmoidal air cells and migrated to the brain ventricular system in 22 years. Accordingly, conservative management of intracranial retained bullets is recommended.