Mesothelioma is more likely to metastasize by local invasion, and metastases to the nervous system are rare. There are currently 10 reported cases of spinal cord compression as a result of mesothelioma. We report a 74-year-old patient with sarcomatoid mesothelioma that spreads across the dura into the spinal cord at T4/T5 level. This case report illustrates an unusual presentation of spinal cord compression by mesothelioma. It details the presenting symptoms, examinations and management of the patient and provides an overview of other potential metastatic sites of mesothelioma.