It is extremely rare for cancer to present as an intramedullary spinal cord metastasis. The authors report on a case of a 74-year-old woman presenting with progressive tetraparesis to metastatic colon adenocarcinoma in the spinal cord. A review of the literature reveals that intramedullary localization is associated with a very short life expectancy, with a median survival of 3-4 months from the time of the diagnosis;nevertheless microsurgical removal of tumor can improve quality of life.