A 57-year-old man with a known diagnosis of metastatic prostate cancer presented to the neurosciences centre complaining of increasing bilateral lower limb weakness and sensory changes over a period of several weeks. There was also long-standing back pain. He had initially been managed with radical radiotherapy and hormonal manipulation with cyproterone acetate (Zoladex), but following disease progression had been changed to palliative chemotherapy with mitoxantrone and prednisolone. This had been terminated early following a significant pulmonary embolus and he was currently on symptomatic treatment only. Examination confirmed bilateral symmetrical reduced power and reflexes in both lower limbs, with altered sensation distal to the level of the upper abdomen. A presumptive diagnosis of spinal cord compression secondary to spinal metastases was made. MRI of the entire spine was performed. Selected sagittal (Figure 1) and axial (Figure 2) images are shown.