Impact of overlapping newer generation drug-eluting stents on clinical and angiographic outcomes: pooled analysis of five trials from the international Global RESOLUTE Program

<h3></h3> We present a 50-year-old lady with 6-months’ history of episodes of feeling weak with legs giving way triggered by sudden change of position or head-turning and no loss of consciousness. She had left tinnitus for years and one year worsening migraines with fortification spectra, visual blurring, and vertigo. ENT made a diagnosis of vestibular migraines. Her neurological examination was normal and attempted provocation of attacks with sudden changes in position and Dix-Hallpike was unsuccessful. Brain MRI revealed a large lesion obstructing foramina of Luschka-Magendie giving rise to obstructive hydrocephalus. Neuro-ophthalmology review showed bilateral papilledema and no evidence of Parinaud’s syndrome (no convergence retraction nystagmus or tectal pupils). Tumour biomarkers (bHCG-AFP-AlkPh-LDH) and body CT scan were normal. She underwent urgent CSF diversion. MDTs confirmed radiological diagnosis of epidermoid cyst awaiting debulking. Episodic headaches/vertigo with head-turning are described in Bruns syndrome manifesting as abrupt headaches, vertigo, vomiting provoked by changes in head position due to intermittent obstructive hydrocephalous (mass lesion and ball-valve mechanism). We propose patient’s acute episodes of lower limb weakness were similar phenomenon highlighting importance of imaging in stereotypical attacks after triggers.