Mi Woon Kim

Pseudo-Froin's syndrome, xanthochromia with high protein level of cerebrospinal fluid

Froin’s syndrome is characterized by marked cerebrospinal fluid (CSF) xanthochromia (yellow discoloration of the CSF) and hypercoagulability due to increased protein content. The cause of the high protein content of the spinal fluid is meningeal irritation and inflammation. Pseudo-Froins syndrome has been described as stagnation of the CSF distal to a spinal block due to spinal disc bulging or tumors [1]. A 54-year-old man with paraplegia was admitted to the urology department of our institution for follow-up of a bladder wall malignancy. The patient had suffered from paraplegia for 20 years because of a thoracic spine burst fracture (T5-7) and dislocation. He had undergone operative correction to maintain the curvature of the spine. The patient was currently scheduled for a urinary bladder wall biopsy. At the time of his admission, the patients vital signs were stable and all laboratory findings including pulmonary function tests and arterial blood gas analysis were within normal limits. Magnetic resonance imaging and computed tomography scans of the brain/spine showed no specific abnormal findings except thoracic spine destruction and dislocation. No motor or sensory abnormalities were found in the upper chest or upper extremities. Because the patient wished to maintain alertness during the operation, it was planned to perform the surgery under spinal anesthesia. The first time spinal anesthesia was performed, the CSF flow was very scanty and sticky, and the color was dark yellow. “Give” was felt, and the CSF color was judged to be due to a traumatic tap. Spinal drug administration was done after CSF confirmation by aspiration. The patient’s mental status and vital signs, especially respiration, were stable throughout the operation following the successful spinal anesthesia. No specific problems such as headache, reflex tachycardia, or sweating were observed in the perioperative period. At the second spinal anesthesia for bladder-cancer follow-up surgery, lumbar spinal pressure was measured. The CSF was observed to not drain freely due to low spinal pressure, below 1 cmH2O, and thick density. The CSF was also observed to be an extraordinarily dark yellow color and very sticky, and CSF was collected by aspiration (Fig. 1). Cell count, cytology, electrophoresis, and culture of the CSF were