Context: We present an apparently singular case in the literature about metal toxicity from a Firearm Projectile (FAP) through direct contact with the spinal cerebrospinal fluid without pathological increase of lead serum levels, but causing an exuberant and debilitating neurological condition.
Case Report: Male, 40-year-old with historic of multiple gunshot wounds, retaining two FAPs in contact with the spine, presented gradual cognitive decline three years later, associated with epileptic seizures and urinary retention. Computed Tomography (CT) evaluation revealed dissemination of numerous hyperdense images bordering cortical gyri, brainstem and cerebellar regions associated with diffuse cortical atrophy symmetrically. The two projectiles were visualized around C6-C7 and L2-L3 levels, inside the medullar canal. Abundant deposit metal material was observed (attenuation up to +3071 Hounsfield units) in meninges along the entire spine. Other complementary exams results were normal, including the lead serum level (38 ?g/dL). The patient was submitted to FAP surgical removal. Six months later, he had a remarkable rehabilitation with improvement of the Mini-Mental State Examination from “not testable” to score 17, as well as reduction in the attention fluctuation and improvement in motor and coordination tests.
Discussion: Although rare, lead poisoning from retained FAP in contact with the cerebrospinal fluid is a well described gunshot wounds complication in the literature. However, this patient presented exceptional radiological findings and did not present a pathological increase in serum levels of lead, necessary for such diagnosis.
Conclusion: We considered that
this patient had an encephalic and meningeal intoxication by metal, probably
lead. Besides that, the rarity of this clinical complication and the
singularity of those radiologic features must emphasize the use of the CT in
the diagnosis of this condition and the importance of the surgical treatment.