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A case of suspected radiation myelitis based on clinical history, previous irradiation, neurologic deficit in the irradiated volume, and normal myelogram is reported. At autopsy, intramedullary metastatic disease was found, but no radiation damage. All radiation details must be considered before making the diagnosis of radiation myelitis with confidence. It is important not to exclude other potentially helpful treatment, such as surgery or chemotherapy, by the presumptive diagnosis of radiation myelitis.

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