Teaching NeuroImages: Bruns syndrome caused by intraventricular neurocysticercosis.

A 24-year-old woman presented with 2 months of episodic vertigo, vomiting, and headache triggered by abrupt head movements, lasting from a few minutes to 1 hour. She was asymptomatic between the attacks and had mild gait ataxia on examination. Brain MRI revealed obstructive hydrocephalus and a cystic lesion in the fourth ventricle (figures 1 and 2). Her symptoms subsided after cyst excision; a histopathologic diagnosis of neurocysticercosis was made. This clinical picture matches the Bruns syndrome, due to a mobile ventricular mass producing episodic hydrocephalus on changing head posture.1,2 Cysticercosis of the fourth ventricle can be fatal and mandates prompt neurosurgical treatment.