Delayed oedema in the pyramidal tracts remote from intracerebral missile path following gunshot injury.

A 60-year-old man developed a severe left hemiparesis and central facial palsy, accompanied by somnolence and dysarthria 9 days after a gunshot wound to the right temporal region, from which he slowly recovered over 3 months. MRI disclosed bilateral oedema of the pyramidal tracts. This was interpreted as a consequence of the impact of the pressure wave caused by the bullet, after excluding an infectious or vascular cause.