Images in Neurology |

Bruns Nystagmus in Cerebellopontine Angle Tumor

Ramanathan Venkateswaran, MD; Ranjan Gupta, MD; Rathinam Palamalai Swaminathan, MD
JAMA Neurol. 2013;70(5):646. doi:10.1001/jamaneurol.2013.619.
Text Size: A A A
Published online


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.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Contrast-enhanced computed tomographic image of the brain. Vestibular schwannoma is seen in the right cerebellopontine angle. The ventricles are dilated due to increased intracranial pressure.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Oculographic nystagmus waveforms, showing the right-sided coarse nystagmus with an exponentially decreasing slow-phase velocity (A) and the left-sided fine nystagmus with a constant (linear) slow-phase velocity (B).2 R indicates right; L, left.




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles

The Rational Clinical Examination
Origins of Nystagmus

The Rational Clinical Examination
Check for Spontaneous Nystagmus