From the Research
Froin syndrome is primarily caused by the obstruction of cerebrospinal fluid (CSF) flow due to underlying inflammatory or neoplastic conditions, leading to a complete spinal block and resulting in xanthochromia, elevated protein levels, and hypercoagulability of the CSF. The most common causes of Froin syndrome include spinal tumors, spinal cord compression, spinal abscesses, and severe forms of spinal tuberculosis or arachnoiditis, as reported in a comprehensive review of the literature 1. Less frequently, it may result from traumatic spinal injuries, herniated discs causing severe compression, or congenital malformations affecting the spinal canal. According to a recent study, the etiologies of Froin's syndrome can be categorized into neoplasia (33% of cases), non-malignant mechanical causes (27%), infections (27%), non-infectious inflammatory processes (6%), and vascular causes (6%) 1.
The syndrome develops because proteins from blood leak into the trapped CSF below the blockage, while the lack of circulation allows these proteins to accumulate to high concentrations, as described in a case report of Froin's syndrome secondary to traumatic and infectious etiology 2. This protein accumulation causes the CSF to become viscous and form clots when collected during a lumbar puncture. The diagnosis of Froin's syndrome can be challenging, but parallel analysis of ventriculoperitoneal shunt and lumbar CSF can help confirm the diagnosis, as demonstrated in a recent case report 3.
Key points to consider in the diagnosis and management of Froin syndrome include:
- The characteristic triad of xanthochromia, elevated protein levels, and hypercoagulability of the CSF
- The importance of identifying the underlying cause of the spinal block, such as spinal tumors, spinal cord compression, or infections
- The need for prompt treatment to address the underlying cause and prevent further complications, which may include surgical intervention, antimicrobial therapy, or other specific treatments depending on the etiology, as reported in a case of Froin syndrome after spinal cord injury 4 and a case of Froin syndrome due to multiple myeloma 5.
In terms of prognosis, Froin's syndrome holds a poor prognosis, with only 22% of patients recuperating fully after treatment, 22% dying due to the cause leading to Froin's syndrome, and 14% retaining sequelae, as reported in the comprehensive review of the literature 1. Therefore, early diagnosis and treatment are crucial to improve outcomes in patients with Froin syndrome.