Bilateral Abducens Nerve Palsy: An Unusual Manifestation of Subdural Collection in Invasive Breast Cancer with Dural Metastasis.

Dural metastases from breast cancer are uncommon, with fewer than 5% of secondary intracranial tumors. As a presentation, bilateral abducens nerve palsy is extremely rare, making this case clinically significant. This case report emphasizes the need to recognize the unusual neurological manifestations in patients with advanced malignancies and to provide timely diagnosis and management. A 53-year-old woman with advanced breast cancer presented with progressive headaches, vomiting, and vision changes. On neurological examination, bilateral lateral rectus palsy and papilledema were observed. Magnetic resonance imaging (MRI) revealed subdural collection, pachymeningeal thickening, and brain metastases. After symptomatic relief through corticosteroid treatment, the patient was planned for palliative chemotherapy along with supportive treatment. Factors delaying diagnosis, with an emphasis on issues of socioeconomic barriers, pose major challenges to effectively managing such cases. This case focuses on the challenges of diagnosing rare manifestations of metastatic breast cancer like bilateral abducens nerve palsy. Limited access to healthcare, delayed presentations, and the socioeconomic factors influencing patient decisions played a significant role in this case. The early recognition of atypical symptoms, particularly in cases with a malignancy history, will improve patient outcomes. Similarly, multidisciplinary management by oncologists, neurologists, and palliative care specialists will help optimize the management of these cases and enhance the quality of life.