Diagnosis of Froin’s Syndrome by Parallel Analysis of Ventriculoperitoneal Shunt and Lumbar Cerebrospinal Fluid in a Patient with Cervical Spinal Stenosis
Elevated protein levels in cerebrospinal fluid (CSF) can occur in various pathologies and are sometimes difficult to interpret. We report a 62-year-old male patient with subacute neurological deterioration, progressive tetraparesis, and cytoalbumin dissociation in the lumbar CSF. The patient had a p...
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| Format: | Article |
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MDPI AG
2023-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/15/5012 |
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| author | Franca Laura Fries Benedict Kleiser Patricia Schwarz Maria P. Tieck Kornelia Laichinger Annerose Mengel Ulf Ziemann Markus C. Kowarik |
| author_facet | Franca Laura Fries Benedict Kleiser Patricia Schwarz Maria P. Tieck Kornelia Laichinger Annerose Mengel Ulf Ziemann Markus C. Kowarik |
| author_sort | Franca Laura Fries |
| collection | DOAJ |
| description | Elevated protein levels in cerebrospinal fluid (CSF) can occur in various pathologies and are sometimes difficult to interpret. We report a 62-year-old male patient with subacute neurological deterioration, progressive tetraparesis, and cytoalbumin dissociation in the lumbar CSF. The patient had a pre-existing cervical spinal stenosis with mild tetraparesis. Based on the initial cytoalbumin dissociation (protein 938 mg/dL, 4 leucocytes/µL), Guillain–Barré syndrome was initially considered. For further diagnosis, a CSF sample was taken from a pre-existing ventriculoperitoneal shunt, which showed a normal protein and cell count considering the patient’s age (protein 70 mg/dL, 1 leucocyte/µL). In conclusion, we suggest that intermediate aggravation of tetraparesis was due to pneumonia with septic constellation, and the cytoalbumin dissociation was interpreted as Froin’s syndrome (FS) due to spinal stenosis. In this unique case, we were able to prove the -often suspected- case of FS by parallel analysis of ventriculoperitoneal shunt and lumbar CSF. The triad of xanthochromia, high protein levels, and marked coagulation was first described by Georges Froin and occurs in various processes leading to severe spinal stenosis. The altered composition of lumbar CSF might be due to impaired CSF circulation; however, the exact mechanisms of this phenomenon require further investigation. |
| first_indexed | 2024-03-11T00:24:49Z |
| format | Article |
| id | doaj.art-d5ecb079bfe14a3a92bc311e978117bf |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T00:24:49Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-d5ecb079bfe14a3a92bc311e978117bf2023-11-18T23:08:12ZengMDPI AGJournal of Clinical Medicine2077-03832023-07-011215501210.3390/jcm12155012Diagnosis of Froin’s Syndrome by Parallel Analysis of Ventriculoperitoneal Shunt and Lumbar Cerebrospinal Fluid in a Patient with Cervical Spinal StenosisFranca Laura Fries0Benedict Kleiser1Patricia Schwarz2Maria P. Tieck3Kornelia Laichinger4Annerose Mengel5Ulf Ziemann6Markus C. Kowarik7Department of Neurodegeneration, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, 72076 Tuebingen, GermanyDepartment of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, 72076 Tuebingen, GermanyDepartment of Neurology and Stroke, Hertie-Institute for Clinical Brain Research, University of Tuebingen, 72076 Tubingen, GermanyDepartment of Neurology and Stroke, Hertie-Institute for Clinical Brain Research, University of Tuebingen, 72076 Tubingen, GermanyDepartment of Neurology and Stroke, Hertie-Institute for Clinical Brain Research, University of Tuebingen, 72076 Tubingen, GermanyDepartment of Neurology and Stroke, Hertie-Institute for Clinical Brain Research, University of Tuebingen, 72076 Tubingen, GermanyDepartment of Neurology and Stroke, Hertie-Institute for Clinical Brain Research, University of Tuebingen, 72076 Tubingen, GermanyDepartment of Neurology and Stroke, Hertie-Institute for Clinical Brain Research, University of Tuebingen, 72076 Tubingen, GermanyElevated protein levels in cerebrospinal fluid (CSF) can occur in various pathologies and are sometimes difficult to interpret. We report a 62-year-old male patient with subacute neurological deterioration, progressive tetraparesis, and cytoalbumin dissociation in the lumbar CSF. The patient had a pre-existing cervical spinal stenosis with mild tetraparesis. Based on the initial cytoalbumin dissociation (protein 938 mg/dL, 4 leucocytes/µL), Guillain–Barré syndrome was initially considered. For further diagnosis, a CSF sample was taken from a pre-existing ventriculoperitoneal shunt, which showed a normal protein and cell count considering the patient’s age (protein 70 mg/dL, 1 leucocyte/µL). In conclusion, we suggest that intermediate aggravation of tetraparesis was due to pneumonia with septic constellation, and the cytoalbumin dissociation was interpreted as Froin’s syndrome (FS) due to spinal stenosis. In this unique case, we were able to prove the -often suspected- case of FS by parallel analysis of ventriculoperitoneal shunt and lumbar CSF. The triad of xanthochromia, high protein levels, and marked coagulation was first described by Georges Froin and occurs in various processes leading to severe spinal stenosis. The altered composition of lumbar CSF might be due to impaired CSF circulation; however, the exact mechanisms of this phenomenon require further investigation.https://www.mdpi.com/2077-0383/12/15/5012Froin’s syndromecervical spinal stenosisventriculoperitoneal shuntlumbar punctureelevated CSF protein |
| spellingShingle | Franca Laura Fries Benedict Kleiser Patricia Schwarz Maria P. Tieck Kornelia Laichinger Annerose Mengel Ulf Ziemann Markus C. Kowarik Diagnosis of Froin’s Syndrome by Parallel Analysis of Ventriculoperitoneal Shunt and Lumbar Cerebrospinal Fluid in a Patient with Cervical Spinal Stenosis Journal of Clinical Medicine Froin’s syndrome cervical spinal stenosis ventriculoperitoneal shunt lumbar puncture elevated CSF protein |
| title | Diagnosis of Froin’s Syndrome by Parallel Analysis of Ventriculoperitoneal Shunt and Lumbar Cerebrospinal Fluid in a Patient with Cervical Spinal Stenosis |
| title_full | Diagnosis of Froin’s Syndrome by Parallel Analysis of Ventriculoperitoneal Shunt and Lumbar Cerebrospinal Fluid in a Patient with Cervical Spinal Stenosis |
| title_fullStr | Diagnosis of Froin’s Syndrome by Parallel Analysis of Ventriculoperitoneal Shunt and Lumbar Cerebrospinal Fluid in a Patient with Cervical Spinal Stenosis |
| title_full_unstemmed | Diagnosis of Froin’s Syndrome by Parallel Analysis of Ventriculoperitoneal Shunt and Lumbar Cerebrospinal Fluid in a Patient with Cervical Spinal Stenosis |
| title_short | Diagnosis of Froin’s Syndrome by Parallel Analysis of Ventriculoperitoneal Shunt and Lumbar Cerebrospinal Fluid in a Patient with Cervical Spinal Stenosis |
| title_sort | diagnosis of froin s syndrome by parallel analysis of ventriculoperitoneal shunt and lumbar cerebrospinal fluid in a patient with cervical spinal stenosis |
| topic | Froin’s syndrome cervical spinal stenosis ventriculoperitoneal shunt lumbar puncture elevated CSF protein |
| url | https://www.mdpi.com/2077-0383/12/15/5012 |
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