Intramedullary Schwannoma of the Conus Medullaris Presenting With Progressive Paraparesis: A Rare Case From a Resource-Limited Setting.

Intramedullary schwannomas of the conus medullaris are exceptionally rare, accounting for less than 1% of all spinal schwannomas. Their clinical presentation is often nonspecific, and radiological features closely mimic more common intramedullary tumors such as ependymomas, leading to frequent diagnostic challenges. We report the case of a 51-year-old Tanzanian male who presented with a 2-year history of progressive lower back pain, bilateral lower limb weakness, and urinary incontinence. Magnetic resonance imaging (MRI) demonstrated an intradural intramedullary lesion at the conus medullaris (T11-L1), initially suggestive of myxopapillary ependymoma. Subtotal surgical excision was performed to preserve neurological function, and histopathological analysis confirmed a benign schwannoma. Postoperatively, the patient experienced partial neurological recovery and is undergoing multidisciplinary follow-up and rehabilitation. This case underscores the importance of considering schwannoma in the differential diagnosis of conus medullaris lesions and highlights that even in resource-limited settings, subtotal resection can provide meaningful symptom relief and functional improvement.