Cerebrospinal fluid (CSF), a colorless, transparent fluid present in the ventricles and subarachnoid space, 70% of which is produced in the choroidal plexus of the ventricles, and the rest of the cerebrospinal fluid is formed in the cell space between the brain and spinal cord.
Normal cerebrospinal fluid is a colorless, clear, clear, clot-free, precipitated fluid. Have you ever seen coagulated cerebrospinal fluid?
Image credit: N Engl J Med 2016; 374:1076
A patient with lower extremity weakness underwent a lumbar puncture and found cerebrospinal fluid as shown above.
Based on the introduction above, what abnormalities do you think the patient is likely to have?
1. Elevated bilirubin
2. Pseudomonas aeruginosa
3. Lymphocytosis
4. Bleeding disorders
5. Elevated protein
©Pexels
<h1 class="pgc-h-arrow-right" data-track="17" > the answer is revealed</h1>
A 64-year-old man presents for 1 week with progressive weakness in both lower extremities. Neurologic examination shows paralysis of both lower extremities and sensory hypofunction below L1-L2 levels.
Patients have pacemaker insertion and therefore cannot complete MRI.
Given the patient's atrial fibrillation and prolonged prothrombin time, the presence or absence of a spinal cord hematoma needs to be ruled out.
Computed tomography (CT) of the spine only reveals degenerative disc lesions.
Lumbar puncture: CSF is yellowish brown, viscous, and coagulates in a test tube (Figure A). Protein levels in CSF exceed 1500 mg/dL and glucose levels are 45 mg/dL (2.5 mmol/L). There are nuclear cells in CSF<1/mm³, and Gram stains and bacterial culture results are negative.
Floin syndrome
Elevated CSF protein levels, yellowish-brown, and hypercoagulable are pathological features of floin syndrome.
This syndrome can occur when a spinal mass blocks the CSF circulation or when meningitis causes meningeal irritation.
CT myelography suggests that a large intradural, extramedullary lesion compresses the spinal cord at T11-T12 (Figure B, Arrow Number).
Patients underwent T11, T12 total laminectomy, and L1 partial laminectomy, and the tumor was removed; pathological examination confirmed as a benign schwannoma (schwannoma). The patient did not receive chemoradiotherapy. After 1 month of rehabilitation, the patient's feelings improved, but the leg was still paralyzed.
Source of the case
N Engl J Med 2016;374:1076
Copyright Information
This article was translated, written or commissioned by the NEJM Frontiers of Medicine, a collaboration between J-Med Medical Research and Education Group (J-Med) and the New England Journal of Medicine (NEJM). The full text of the Chinese translation and the included charts are exclusively licensed by NEJM Group. If you need to reprint, please leave a message or contact the [email protected]. Unauthorized translation is an infringement and the copyright owner reserves the right to pursue legal liability.