Author Affiliations: Department of Medicine, Indira Gandhi Medical College and Research Institute (Dr Venkateswaran) and Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (Dr Swaminathan), Pondicherry, and Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow (Dr Gupta), India.
A 35-year-old woman presented with insidious onset of hearing loss on the left side along with progressive unsteadiness of gait and diminution of vision. She had features of increased intracranial pressure. Clinical examination revealed gross papilledema in both eyes with secondary optic atrophy. A right-sided lower motor neuron type of facial palsy was present. Corneal reflex was absent on the right side. Eye movements were full. A coarse right-beating nystagmus with rightward gaze and a fine primary-position left-beating nystagmus (which was appreciated by ophthalmoscopy) that increased on leftward gaze, consistent with Bruns nystagmus, was noticed (video). Hence, a space-occupying lesion in the right cerebellopontine angle was considered.
Venkateswaran R, Gupta R, Swaminathan RP. Bruns Nystagmus in Cerebellopontine Angle Tumor. JAMA Neurol. 2013;70(5):646. doi:10.1001/jamaneurol.2013.619