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Bruns Syndrome - An Unusual Presentation.

Sweety Trivedi1, Ashis Datta1, Santosh Trivedi1

  • 1Consultant Neurologist, MD Internal Medicine, DM Neurology, Institute of Neurosciences, West Bengal, India.

Neurology India
|July 10, 2020
PubMed
Summary

Bruns syndrome involves sudden headache, vomiting, and vertigo from head movements due to a mobile lesion causing obstructive hydrocephalus. This case highlights an unusual presentation initially missed by MRI, emphasizing diagnostic challenges.

Keywords:
Bruns syndromeCSF obstructionNCCfourth ventricleintraventricular tumorsobstructive hydrocephalus

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Area of Science:

  • Neurology
  • Neurosurgery
  • Neuroimaging

Background:

  • Bruns syndrome is a rare neurological condition characterized by episodic symptoms like severe headache, vomiting, and vertigo.
  • These symptoms are typically triggered by head movements and result from a mobile intraventricular lesion causing obstructive hydrocephalus.
  • The underlying mechanism is often a ball-valve effect leading to intermittent cerebrospinal fluid (CSF) obstruction.

Observation:

  • This report details an unusual case of Bruns syndrome.
  • The patient's condition was initially not detected by Magnetic Resonance Imaging (MRI).
  • This highlights a potential limitation of standard neuroimaging in diagnosing certain presentations of Bruns syndrome.

Findings:

  • The case demonstrates that Bruns syndrome can present atypically, even with a negative initial MRI.
  • It underscores the importance of considering Bruns syndrome in patients with characteristic symptoms despite non-diagnostic imaging.
  • The mobile deformable intraventricular lesion, though initially occult, was the cause of episodic obstructive hydrocephalus.

Implications:

  • This case expands the understanding of Bruns syndrome's diagnostic spectrum.
  • It suggests a need for careful clinical correlation and potentially advanced or repeat imaging in suspected cases.
  • The findings emphasize the challenges in diagnosing rare neurological conditions and the importance of considering less common etiologies.