Bruns' Nystagmus in Patients With Vestibular Schwannoma

Lloyd, Simon; Baguley, David; Butler, Katy; Donnelly, Neil; Moffat, David A.

doi:10.1097/mao.0b013e3181a32bec

Cited by 31 publications

(21 citation statements)

References 11 publications

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“…In a previous study, vestibular manifestation of CPA tumors included unilateral caloric paresis (87%), contralesional spontaneous nystagmus (27%), and gaze-evoked (12%) and Bruns nystagmus (14%) [15]. Bruns nystagmus is a bilateral nystagmus seen most often in CPA tumors and around 11% of vestibular schwanomma cases and mainly in those with larger tumors [26]. Bruns nystagmus is caused by gaze paretic nystagmus when looking towards the side of the lesion and vestibular nystagmus when looking away from the side of the lesion [25].…”

Section: Chronic Unilateral Combined Vestibulopathymentioning

confidence: 92%

Combined peripheral and central vestibulopathy

Choi

Kee

Park

et al. 2014

VES

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Diagnosis of central vestibulopathy remains a challenge when it is associated with peripheral vestibular dysfunction because neurotological findings from peripheral vestibulopathy may overshadow those from central vestibular involvements. To define the characteristics of disorders involving both peripheral and central vestibular structures, we classified the combined vestibulopathies into four types according to their vestibular manifestations, and describe a typical case in each subtype. Infarction involving the territory of anterior inferior cerebellar artery is the most common cause of acute unilateral cases, whereas tumors involving the cerebellopontine angle should be of prime suspicion in patients with chronic unilateral ones. Wernicke encephalopathy was most common in patients with acute bilateral combined vestibulopathy while degenerative disorders should be considered in chronic bilateral ones. Since the head impulse test (HIT) is mostly positive in combined vestibulopathy, signs of central vestibular dysfunction other than negative HIT should be sought carefully even in patients with obvious clinical or laboratory features of peripheral vestibulopathy.

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Section: Chronic Unilateral Combined Vestibulopathymentioning

confidence: 92%

Combined peripheral and central vestibulopathy

Choi

Kee

Park

et al. 2014

VES

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“…In a study conducted on patients with unilateral vestibular schwannoma, the overall prevalence of Bruns nystagmus was estimated to be 11%. With large tumours having maximal diameter greater than 3.5 cm, the prevalence was observed to be higher (92% of patients had nystagmus, 67% of whom had Bruns nystagmus) 2. It comprises of a coarse, high-amplitude horizontal nystagmus with low oscillatory frequency as the patient looks towards the side of the lesion, but a fine, low-amplitude, high-frequency primary-position nystagmus that increases as the patient looks to the side opposite the lesion 3.…”

Section: Descriptionmentioning

confidence: 93%

Bruns nystagmus: an important clinical clue for cerebellopontine angle tumours

et al. 2018

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DesCripTionA 24-year-old woman presented with gradual-onset left-sided hearing loss, progressive diminution of vision, headache and unsteadiness of gait. Comprehensive clinical evaluation revealed a left-sided lower motor neuron type of facial nerve palsy (figure 1), bilateral papilloedema, sensory loss in the distribution of ophthalmic branch of the left trigeminal nerve and cerebellar ataxia. Sensorineural hearing loss and absent corneal reflex were also observed on the left side. A coarse, left-beating nystagmus with leftward gaze and a fine primary-position rightbeating nystagmus which increased on rightward gaze, consistent with Bruns nystagmus (video 1), were appreciated. In view of the clinical findings, a diagnosis of a space-occupying lesion involving the left cerebellopontine angle was considered. MRI of the brain documented a space-occupying lesion (4×3.5 cm) in the left cerebellopontine angle, most likely a vestibular schwannoma (figures 2 and 3). The condition was explained to the patient and the need for surgical intervention. However, on being informed of the relative inexperience of neurosurgical interventions in such cases at our centre, she chose to attend a different medical facility with a higher surgical expertise, and was subsequently lost to follow-up. Bruns nystagmus is usually associated with large tumours of the cerebellopontine angle causing significant brainstem distortion, compression of the flocculus and/or vestibulocerebellum. In a study conducted on patients with unilateral vestibular schwannoma, the overall prevalence of Bruns nystagmus was estimated to be 11%. With large tumours having maximal diameter greater than 3.5 cm, the prevalence was observed to be higher (92% of patients had nystagmus, 67% of whom had Bruns nystagmus).2 It comprises of a coarse, high-amplitude horizontal nystagmus with low oscillatory frequency as the patient looks towards the side of the lesion, but a fine, low-amplitude, high-frequency primary-position nystagmus that increases as the patient looks to the side opposite the lesion.3 Bruns nystagmus primarily is a form of jerk nystagmus, characterised by alternating slow and fast components. After focusing an object on the fovea, failure of gaze-holding results in the deviation of the eyes, contributing to the slow component of the nystagmus. Subsequently, corrective saccades, in an effort to refocus the object of interest back on the fovea, contribute to the fast

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“…), space‐occupying lesions (Rett ; Karatas ; Lloyd et al. ), syringobulbia (Weissman et al. ; Nogués et al.…”

Section: Neural Integrator Failureunclassified