Neuroendoscopic Management of Lateral Ventricular Neurocysticercosis Presenting as Brun's Syndrome

Abstract

Background: Brun's syndrome is a phenomenon characterized by sudden onset of severe headache, vomiting associated to a vestibular syndrome triggered by an abrupt movement of the head.

Case presentation: We present a case of a 12-year-old female patient with headache, vertigo, and vomiting; magnetic resonance imaging (MRI) was suggestive of a cystic intraventricular mass in the frontal horn of the left lateral ventricle. The patient underwent endoscopic exploration for the excision of cyst with complete postoperative recovery and histopathology suggestive of intraventricular neurocysticercosis.

Discussion: Brun's syndrome is caused by a mobile deformable intraventricular mass leading to an episodic obstructive hydrocephalus resulting from an intermittent or positional CSF obstruction with elevation of intracranial pressure due to the ball valve mechanism. Treatment is mainly surgical, preferably by the neuroendoscopic technique as it has an advantage of performing septostomies and third ventriculostomies in addition to cyst removal, making this procedure practical for most cases of ventricular cysticercosis even in emergencies.

Keywords: Brun’s syndrome; intraventricular SOL; neurocysticercosis; neuroendoscopy.

Figure 1

Preoperative MRI. (A) T1 image hypointense lesion with a tiny solid nodule causing displacement of the septum pellucidum to the right. (B) T2 hyperintense lesion. (C and D) No contrast enhancement of lesion

Figure 2

Intraoperative. (A) Large cyst with gritty surface and normal ependyma of the ventricle in the background. (B) Final portion of cyst being removed. (C) Normal ventricular anatomy postexcision of the cyst. (D) Cyst held with an endoscopic grasper

Figure 3

Postoperative CT. (A and B) Axial and coronal scans showing complete excision of the cyst, with septum pellucidum attaining its normal midline position