Coarctation of aorta causes multiple enlarged collaterals which shunt blood from the supra to infra coarctation segment of aorta and anterior spinal artery (ASA) is one such route. Such collaterals can result in compressive myelopathy. However, hematomyelia secondary to aneurysmal dilatation of the ASA is distinctly rare. A 36-year-old male presented to the department of neuroradiology with sudden onset weakness of all four limbs associated with loss of sensation of below the neck and urinary and fecal incontinence of two months duration. On examination he had 0/5 motor power in the lower limbs and 3/5 power in the upper limbs and sensory loss below C6 level Deep tendon reflexes were brisk and plantars were bilaterally up going. Magnetic resonance images (MRI) [Figure la to d] showed hematomyelia [Figure la to d] extending into the subarachnoid space (not seen in the image).
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