Intrasyringal hemorrhage of the cervical cord associated with Chiari type I malformation--case report

A 34-year-old male presented with intrasyringal hemorrhage associated with Chiari type I malformation manifesting as a history of repetitive severe pain around his neck and back and progressive sensory disturbance. Magnetic resonance imaging clearly demonstrated syringomyelia at the cervical region associated with Chiari type I malformation and hemorrhage in the syrinx which was strongly suggestive of bleeding into pre-existing syringomyelia or Gowers' syringal hemorrhage. Irrigation of the syrinx and syringosubarachnoid shunting were performed, but rebleeding occurred causing shunt malfunction. Shunt revision was performed, but a new cavity developed above the original syrinx. Foramen magnum decompression resulted in successful reduction of the new syrinx and subsequent neurological improvement. Simultaneous foramen magnum decompression and syrinx irrigation may be a better approach to treat this disease.