Silent Tumours, Loud Clues: Case Series of LR Palsy and Papilledema in Young Females

Abstract

Unilateral sixth nerve palsy associated with papilledema is an alarming clinical finding that often indicates raised intracranial pressure. The purpose is to highlight uncommon presentations of sixth nerve palsy with papilledema as early indicative signs of space-occupying lesions in young females. We present two young female patients who reported experiencing a sudden onset of binocular diplopia and headaches. Ocular examination revealed limitations of abduction in the right eye, along with bilateral disc oedema. Neuroimaging identified significant intracranial pathology in both cases—one with an intracranial haemorrhage causing mass effect secondary to Ewing sarcoma and the other with cerebellopontine angle vestibular schwannoma causing hydrocephalus. These cases highlight the importance of thorough ophthalmic evaluation for complaints of headache, which could be a window to neurological lesions. It is crucial to conduct a thorough fundus evaluation and early neuroimaging in young patients, as prompt diagnosis is crucial in preventing permanent visual and neurological complications.