Cerebrospinal fluid (CSF) drainage is a routinely used adjunct to thoracoabdominal aortic surgery which may reduce the incidence of preoperative paraplegia by improving spinal cord perfusion. However, this procedure infrequently causes complications. Bloody or bloody-tinged CSF may be associated with intracranial or spinal hematoma. We present herein a case of bloody CSF during the replacement of the descending thoracic aorta.