Management and Treatment of Bruns Nystagmus

Immediate Diagnostic Workup

• The American College of Radiology recommends MRI of the brain without and with IV contrast as mandatory to identify the causative lesion, as Bruns nystagmus indicates significant mass effect and brainstem distortion 1, 2
• CT imaging has no role in evaluation, as it provides inadequate visualization of posterior fossa structures 3

Clinical Characteristics to Document

• The pattern of gaze-dependent bidirectional nystagmus does not fatigue and is not suppressed by visual fixation, confirming its central origin, according to Praxis Medical Insights 1, 4

Critical Pitfalls to Avoid

• The American College of Radiology and Praxis Medical Insights warn against mistaking Bruns nystagmus for benign peripheral vestibular disorders, as it definitively indicates central pathology requiring urgent intervention 1, 4