Abstract Patient initially presented to our facility with a 3 year history of limb weakness. The limb weakness started mainly with the right upper limb associated with pains that were radiating to the neck region. They had visited several local hospitals for treatment but had no improvement. One year later he developed low limb weakness, was on physiotherapy for a long time with no improvement, until 1/12 ago when he developed complete paralysis of both low limbs making him bound to use of wheelchair. He had an accompanied history of cervical and thoracic spine pains that were radiating to the chest. No history of trauma. MRI showed an expansile intramedullary cystic lesion seen throughout the length of the spinal cord with inhomogeneous post contrast enhancement, highly suggestive of astrocytoma. Ddx: Hemangioblastoma. On examination, he was not pale, no jaundice no edema, wheelchair bound, with Scoliosis. Vitals were within normal limit, with muscle atrophy and muscle power- RUL ⅗. LUL ⅘, RLL ⅗. LLB ⅖, with bilateral knee hyperreflexia with significant disuse atrophy. Pain scale 6/10. He was a secondary school student. His parents do menial jobs to support their family and would delay clinic reviews due to lack of finances.