Intramedullary spinal cord metastasis (ISCM) is a rare complication of systemic malignant neoplasms[1
]. Lung and breast carcinomas are the most common primary sources. The cervical spinal cord appears to be the most common location of ISCM possibly because of its larger size and abundant vascular supply[2
]. Hematogenous dissemination via either arterial route or vertebral venous plexus was postulated to be responsible for the most cases[2
]. The common coexistence of visceral metastatic disease supports the idea of dissemination through the arterial route.
MRI with gadolinium contrast enhancement is currently the gold standard of choice for the diagnosis of spinal cord compression, including ISCM[2-4]. Gadolinium MRI has a high sensitivity in identifying intramedullary lesions. Prior to the availability of MRI, myelography was usually employed with a high false negative rate. After the introduction of MRI technology, the diagnosis of spinal cord lesions has been revolutionized.
ISCM is rarely responsive to treatment with a very unfavorable prognosis. The median survival after the diagnosis of ISCM is measured in weeks to a few months. Conservative palliative approaches using radiation, steroids and chemotherapy have been adopted due to systemic disease with improvement in the quality of life in certain cases[3,4].Treatment with steroids may decrease the pain and cause transient improvement in neurological findings. The outcome essentially depends on the degree and severity of neurologic deficit. Radiotherapy is the recommended treatment but effective only if administered early before paraplegia develops. Surgery is usually deferred except for rare patients with localized tumors achieving quality survival after microsurgery.