Abstract
Background: Headache is a routine complaint in primary care; however, when is associated with ocular pain and morning aggravation, it needs examination for increased intracranial pressure (ICP). Case Presentation: A 16-year-old male presented with a one-month history of constant headache and ocular pain, worse in the morning and exacerbated by bending forward. He complained nausea but no vomiting. Ophthalmic examination showed a best-corrected visual acuity (BCVA) of 0.7 in both eyes, alternating exotropia, and normal intraocular pressure. Fundoscopy indicated bilateral optic disc edema. Visual field testing proved enlargement of the blind spot. Neuroimaging via MRI showed a posterior fossa mass, later diagnosed as medulloblastoma. Conclusion: This case demonstrates the pivotal role of a thorough history and ophthalmic examination in diagnosing medulloblastoma presenting with papilledema. In young patients with headache and signs of increased ICP, prompt neuroimaging is critical to rule out malignancy.