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Moving Bullet Syndrome can be a Rare Complication of Firearm Related Brain Injury

Categories: Firearm Related Brain Injury

The Question

What are the consequences of Moving Bullet Syndrome?

Past Studies

Past Studies were based on military firearm-related injuries. The weapons used by the military and by civilians are different and result in different brain injury characteristics. Information is lacking regarding civilian firearm related brain injuries. Prior studies support that bullet fragments remaining in the brain did not increase the risk of infection after injury. Surgeons historically chose not to remove a bullet or bullet fragments if it was positioned where further tissue injury from surgery would be risky. Studies dating back to the early 1900s describe that bullets remaining in the brain can move. Documented unpredictable complications resulting from the bullet migration include severe neurological consequences; bullet migration to the spinal cord; or to a brain ventricle, causing hydrocephalus. In cases when persons experienced cognitive or motor decline, a clear improvement was noted once the bullet was removed. The movement of the bullet itself can suggest that an abscess (infection) has occurred in the brain. Animal studies reveal that toxic reaction to bullet material can cause tissue softening and death. In these instances, copper jacketed bullets caused the greatest degree of toxic reaction and consequential bullet movement. No evidence of migration was noted with nickel or lead coated bullets.

This Study

This Study examines two cases of civilians with spontaneous migration of bullets that remained in their brains. Neither of the persons had a brain abscess. Both persons had copper-jacketed bullets. In both cases, the persons experienced a decline in abilities and increase in medical symptoms when the bullet had moved. This happened at different points along their recovery continuum. Once the bullets were surgically removed, their conditions improved and they were discharged to home.

Who May Be Affected By These Findings

Persons who have bullets or bullet fragments remaining in their brains and healthcare service providers examining those persons.


No definitive practice guidelines for surgical treatment of civilian or military penetrating brain injuries existed at the time of this article’s publication. The authors state further research is needed to assess the specific damage that particular bullet types cause.

Bottom Line

Persons who have bullets or bullet fragments remaining in their brains and healthcare service providers examining those persons need to be aware of the potentially devastating effects of Moving Bullet Syndrome. Persons who demonstrate a marked decline in functioning and medical distress during their recovery process should be evaluated and surgical removal of the bullet considered.

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Find This Study

Zafonte, R. D.; Watanabe, T.; & Mann, N. R. (1998). Moving bullet syndrome: A complication of penetrating head injury. Archives of Physical Medicine Rehabilitation, (79), 1469-1472.


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