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Migrating intracranial bullets are a dilemma to neurosurgeons, as their management is challenging, and the removal process is associated with high mortality and morbidity rates. They are also associated with alterations in consciousness and focal neurological defects. We herein report a 40-year-old man with a retained intracranial AK-47 bullet for 22 years, admitted to our emergency department with decreased level of consciousness. He was diagnosed with meningitis and obstructive hydrocephalus,doi:10.5812/jamm.17168 fatcat:qezo4f4xsjc5pelyqx7m7zw5wq