An unusual bullet tracing from the cranium to the thoracic intramedullary area following a tired bullet injury: a pediatric case report.

Tired bullet or falling bullet injuries cause mortality and morbidity, especially in residential areas. Due to their potential velocity, they can penetrate the calvarium and extend to deeper intracranial areas, posing a heightened risk of mortality in pediatric cases due to low bone resistance. We present a pediatric patient with an unusual bullet trajectory caused by a falling bullet, a scenario not documented before. A 5-year-old boy was brought to the emergency department after a sudden loss of consciousness while playing outside. Cranial CT showed a bullet entry wound in the right parietal bone with a comminuted fracture and a hyperdense bullet tract extending through the right lateral ventricle's temporal horn, right cerebellar peduncle, and right cerebellar hemisphere to the foramen magnum. The bullet's trajectory extended from the cranium to the spinal canal. A spinal scan showed hyperdensity consistent with an intradural intramedullary bullet core at the T5 level. After stabilization, the bullet was surgically removed and sent for ballistic analysis. Falling bullet injuries have a high mortality rate in children. Given the unpredictable bullet trajectory, the bullet core may not be seen on cranial imaging, highlighting the importance of spinal imaging. To our knowledge, this case represents the first reported instance of a falling bullet injury with such an unusual trajectory.