Eye a gateway to brain-nystagmus as a presentation of brain ependymoma

Ependymomas are the third most common brain tumours in children, with the posterior fossa being the most frequent site. Early diagnosis can be challenging due to nonspecific symptoms. Authors report the case of a 6-year-old male who presented with a two-month history of intermittent occipital headaches and a one-month history of vomiting. Neurological examination revealed bilateral horizontal nystagmus on lateral gaze, but no gait abnormalities or other cerebellar signs. MRI of the brain demonstrated a large, heterogeneously enhancing lesion in the posterior fossa (5.7×5.2×4.3 cm), causing mass effect. The patient underwent midline suboccipital craniotomy with gross total resection of the tumour and placement of a right parietal Ommaya reservoir. Histopathology confirmed a WHO Grade 3 ependymoma. Postoperatively, the child remained neurologically intact and was discharged symptom-free. This case highlights the importance of early recognition of posterior fossa tumours in children with subtle but progressive symptoms. Timely neuroimaging and surgical intervention can lead to favourable outcomes even in high-grade pediatric ependymomas.