SHM Converge Scientific Abstract ePoster Gallery-Froins Syndrome: Indicator of a Possible Sinister Diagnosis

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Froin’s syndrome is a rare cerebrospinal fluid (CSF) pattern characterized by xanthochromia, very high protein, and hypercoagulable CSF, often suggesting impaired CSF flow from a spinal block. It can be associated with meningitis, spinal tumors, epidural abscess, trauma, Guillain-Barré syndrome, or multiple myeloma.<br /><br />This case involved a 48-year-old man with AIDS who presented with 3 days of slurred speech, disorientation, fever, and body aches. Initial stroke and pneumonia workups were negative, and he was started on antimicrobials. By day 3, he developed severe headache and neck stiffness. Lumbar puncture revealed yellow CSF with xanthochromia, protein of 1862 mg/dL, and glucose of 18 mg/dL, raising concern for meningitis and possible subarachnoid hemorrhage.<br /><br />Soon after, he developed new bilateral lower-extremity weakness, followed by neck and back pain, sensory loss, and bowel/bladder incontinence. Although early brain and lumbar imaging were negative, the CSF findings suggested Froin’s syndrome and prompted a multilevel spine MRI. This revealed a 14.5 cm multiloculated extradural lesion from C7 to T6 causing critical spinal canal stenosis, highly suspicious for a spinal epidural abscess.<br /><br />The patient was urgently transferred to a neurosurgical center and underwent C7 hemilaminectomy with T1–T6 laminectomy the same day. He improved gradually and was discharged to rehabilitation after 13 days.<br /><br />This case highlights that Froin’s syndrome can be an important clue to spinal obstruction and neurosurgical emergencies. When CSF protein is markedly elevated, clinicians should strongly consider spinal imaging to evaluate for an abscess, tumor, or other compressive lesion.

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Lavina H. Lakdawala

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Author List Anunaya Aashish, Bidisha Baral, Carolina De La Porte, Lavina H. Lakdawala, Mushtaq Bhat, Teja Sree Vallapu Reddy

Category Clinical Vignettes

Concept Froin Syndrome

Concept Xanthochromia

Concept Cerebrospinal Fluid Protein

Concept Cerebrospinal Fluid Stasis

Concept Impaired Cerebrospinal Fluid Circulation

Distinguished Non-Finalist

Presenter Organization Texas Health Resources HEB/Denton

Presenting Author Lavina H. Lakdawala

Track Adult

Keywords

Froin syndrome

cerebrospinal fluid

xanthochromia

spinal epidural abscess

high protein CSF

spinal block

AIDS

lumbar puncture

spinal canal stenosis

neurosurgical emergency

Froin Syndrome

Xanthochromia

Cerebrospinal Fluid Protein

Cerebrospinal Fluid Stasis

Impaired Cerebrospinal Fluid Circulation