title: Gowers' intrasyringeal hemorrhage associated with Chiari type I malformation in Noonan syndrome.
abstract: BACKGROUND
  Idiopathic hemorrhage in a syrinx is a rare entity known as Gowers' intrasyringeal hemorrhage. Bleeding confined to the syrinx cavity causes severe, sometimes acute, neurological deficits. We report a case of intrasyringeal hemorrhage into a preexisting lumbosacral syrinx associated with Chiari type I malformation.
  
  
  METHODS
  A 39-year-old female with Noonan syndrome underwent foramen magnum decompression and a cervical syrinx-subarachnoid shunt for Chiari type I malformation-associated syringomyelia 7 years ago. She presented progressive gait deterioration and acute urinary dysfunction, indicating conus medullaris syndrome. Initial magnetic resonance imaging revealed massive hemorrhage in the intrasyringeal cavity of the conus medullaris. The patient underwent surgical removal of the intrasyringeal hematoma and her neurological symptoms improved postoperatively.
  
  
  CONCLUSIONS
  Although Gowers' intrasyringeal hemorrhage is rare, this entity should be taken into consideration in patients with syringomyelia showing acute neurological deterioration.
authors.affiliation: Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami.ku, Hiroshima 734-8551, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Mitsuhara
authors.affiliation: Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami.ku, Hiroshima 734-8551, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamaguchi
authors.affiliation: Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami.ku, Hiroshima 734-8551, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takeda
authors.affiliation: Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami.ku, Hiroshima 734-8551, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kurisu
keywords: Chiari type I malformation; Noonan syndrome; intrasyringeal hemorrhage; spinal disease; syringomyelia