AbstractBrain metastases are a common complication of lung cancer and remain a major cause of morbidity and mortality worldwide. Although advances in imaging and targeted therapies have improved outcomes in high-income countries, patients in low- and middle-income countries (LMICs) often present late and face significant resource limitations. We report the case of a 56-year-old woman who presented with a two-week history of acute confusion, headache, and right-sided hemiparesis. Neuroimaging revealed a left parieto-temporal brain lesion with mass effect, while chest imaging demonstrated multiple pulmonary nodules, findings consistent with metastatic lung cancer. Despite supportive management with corticosteroids, anticonvulsants, and intensive care, the patient developed recurrent seizures, systemic infection, and respiratory failure, ultimately succumbing two weeks after admission. Histopathological confirmation was not obtained due to her frail condition and lack of consent for postmortem examination. This case highlights the diagnostic and therapeutic challenges of managing metastatic brain tumors in LMICs, where limited access to advanced imaging, surgical interventions, radiosurgery, and targeted therapies contributes to late diagnosis and poor outcomes. Strengthening oncology services, expanding access to modern treatment modalities, and investing in healthcare infrastructure and training are urgently needed to address these disparities.Keywords : Lung cancer; Brain metastases; Tanzania; Oncology disparities; Neuro-oncology

AbstractMetachromatic Leukodystrophy (MLD) is a rare genetic disorder characterized by progressive neurological decline due to the accumulation of sulfatides in the nervous system. In low-resource settings, limited access to advanced diagnostic tools often leads to delays in identifying rare disorders like MLD, resulting in misdiagnosis and late intervention. We describe a 16-month-old boy who presented with lower limb weakness, irritability, feeding difficulties, and skin abnormalities during an acute respiratory infection. Initial work-up suggested conditions such as tuberculosis, lymphoma, or leukemia due to overlapping clinical and laboratory features. However, neuroimaging revealed findings consistent with leukodystrophy, and subsequent genetic testing confirmed a variant in the FBP2 gene associated with childhood-onset leukodystrophy. This case illustrates the diagnostic complexity of MLD in resource-limited environments, where overlapping presentations with more common infectious and hematological conditions often delay recognition. The patient demonstrated partial improvement with antibiotics and Cholecalciferol, underscoring the role of supportive interventions while awaiting definitive diagnosis. This report highlights the urgent need for earlier access to neuroimaging and genetic testing to facilitate timely diagnosis and intervention. Strengthening multidisciplinary collaboration among clinicians, researchers, and policymakers is essential to improve outcomes for patients with rare genetic disorders like MLD, particularly in under-resourced regions

AbstractIntramedullary 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 two-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.Keywords: Schwannoma; Conus medullaris; Intramedullary tumor; Spinal surgery; sub-Saharan Africa; Case report