The

n e w e ng l a n d j o u r na l

of

m e dic i n e

Images in Clinical Medicine

Lindsey R. Baden, M.D., Editor

Froins Syndrome
A

Ria Dancel, M.D.

Mona Shaban, M.D.
University of North Carolina
Chapel Hill, NC
ria.dancel@unchealth.unc.edu

64-year-old man presented with a 1-week history of progressive bilateral weakness in the legs. The neurologic examination showed
paralysis of the legs and decreased sensation starting at the L1L2 level.
Magnetic resonance imaging could not be performed owing to the presence of a
pacemaker. Since the patient had atrial fibrillation and an elevated prothrombin
time, there was concern about a possible spinal hematoma. Computed tomography
(CT) of the spine showed only degenerative disk disease. On lumbar puncture, the
cerebrospinal fluid (CSF) was xanthochromic, viscous, and coagulated in the tube
(Panel A). The protein level in the CSF was more than 1500 mg per deciliter, and
the glucose level was 45 mg per deciliter (2.5 mmol per liter). The CSF contained
less than one nucleated cell per cubic millimeter, and the results of Grams staining and cultures were negative. The combination of elevated protein, xanthochromia, and hypercoagulation of CSF is pathognomonic for Froins syndrome, which
can occur with blockage of CSF flow by a spinal cord mass or with meningeal
irritation from meningitis. CT myelography showed a large intradural, extramedullary lesion at T11T12 (Panel B, arrow), which was compressing the spinal cord.
The patient underwent total laminectomy of T11 and T12 and partial laminectomy
of L1 with tumor resection; a benign nerve-sheath tumor (schwannoma) was diagnosed on pathological analysis. No radiotherapy or chemotherapy was performed.
After 1 month of rehabilitation, the patient had improved sensation but continued
having leg paralysis.

DOI: 10.1056/NEJMicm1509557
Copyright 2016 Massachusetts Medical Society.

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March 17, 2016

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