Glioblastoma multiforme presenting as Froin’s syndrome: a new face of an old foe

Excerpt

A 23-year-old male presented with acute development of headache and lower back pain. Headache was described as debilitating frontal pressure (VAS 7/10), and was preceded by 2 days of nausea and vomiting. At the time of initial examination he was disoriented, had fever, but showed no signs of focal neurological deficit. As CNS infection was suspected, a spinal tap was performed; cerebrospinal fluid (CSF) coagulated in one of the tubes and analysis showed elevated protein levels (12.05 g/L; normal values <0.37). Brain MRI findings are shown in Fig. 1a, b. The patient was referred to our hospital, at which point he had a mild paresis of the right quadriceps femoris with attenuated right patellar reflex. Another cerebrospinal fluid analysis was performed, this time showing xantochromy and protein level exceeding 17 g/L, with cell count of 53/3 and unremarkable cytology. A fundus examination was performed before the spinal tap and was normal. Spine MRI was performed and is shown in Fig. 1c. Five days after admission, the patient suffered a rapid clinical deterioration, developing quadriplegia, bilateral exophthalmus with ophthalmoplegia, and respiratory failure leading to mechanical ventilation. He was alert with preserved speech understanding. The clinical deterioration was not related to the spinal tap.

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