BACKGROUND CONTEXT: Firearm injuries to the spine may cause injury to the neurological structures and/or to the spine, including ligaments and bones. PURPOSE: Patients usually present with symptoms immediately after injury. However, only a few cases have been reported where a patient is neurologically intact after the initial injury but develops deficits several months or years later. Almost all these cases develop delayed neurological deficit because of bullet migration. STUDY DESIGN: Case report. METHODS: A discussion, with a relevant review of the literature, the clinical histories, and radiological findings of two patients who experienced delayed neurological symptoms after gunshot wounds to the spine. RESULTS: One patient presented after 14 years and the other after 5 months from the day of injury. Both cases are unique in that the delayed symptoms appeared because of formation of a reactive mass around the site of bullet impact. Lack of serial imaging studies is a barrier to the exclusion of bullet migration as an alternate cause of delayed symptoms. CONCLUSION: These cases illustrate that retained intraspinal bullets can present with delayed neurological findings secondary to reactive changes around the bullet.
BACKGROUND CONTEXT: Firearm injuries to the spine may cause injury to the neurological structures and/or to the spine, including ligaments and bones. PURPOSE:Patients usually present with symptoms immediately after injury. However, only a few cases have been reported where a patient is neurologically intact after the initial injury but develops deficits several months or years later. Almost all these cases develop delayed neurological deficit because of bullet migration. STUDY DESIGN: Case report. METHODS: A discussion, with a relevant review of the literature, the clinical histories, and radiological findings of two patients who experienced delayed neurological symptoms after gunshot wounds to the spine. RESULTS: One patient presented after 14 years and the other after 5 months from the day of injury. Both cases are unique in that the delayed symptoms appeared because of formation of a reactive mass around the site of bullet impact. Lack of serial imaging studies is a barrier to the exclusion of bullet migration as an alternate cause of delayed symptoms. CONCLUSION: These cases illustrate that retained intraspinal bullets can present with delayed neurological findings secondary to reactive changes around the bullet.
Authors: Randi N Smith; Mark J Seamon; Vinayak Kumar; Andrew Robinson; Justine Shults; Patrick M Reilly; Therese S Richmond Journal: Injury Date: 2017-09-04 Impact factor: 2.586