A 52-year-old white man received irradiation to the right scapula for an unbiopsied lytic lesion. Within 3 months he became cachectic, with weakness in his lower extremity associated with severe dysphagia. Multiple cranial nerve palsies developed with hydrocephalus, and cerebrospinal fluid (CSF) examination showed many adenocarcinoma cells. Magnetic resonance imaging (MRI) revealed bone marrow replacement in the T11 and L5 vertebrae. He had not walked for the previous 2 weeks, but there was no evidence of epidural cord compression. A large left hilar lung mass was detected.