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Intramedullary spinal cord metastasis is rare and the treatment remains controversial. The authors report a case of thoracic intramedullary spinal cord metastasis in a 74-years-old man. The patient was admitted to our hospital due to the weakness of both lower extremities and urinary difficulty. The thoracic magnetic resonance image revealed the enhanced intramedullary mass in T11-12 level. With the conservative management, the symptoms got worsen and he underwent the removal of thoracic mass. The pathologic finding was small cell cancer from the lung. After tumor removal, radiation therapy was done. We discuss the diagnosis, pathophysiology and treatment of the intramedullary spinal cord metastasis. Key words:Intramedullary metastasis;Cancer;Spinal cord.