Abstract
A 49 year old man presented with rapid onset paraparesis, evidence of lower motor neurone features and sensory impairment following a respiratory tract infection. Initially he was treated with intravenous immunoglobulins for suspected Guillain-Barré syndrome (GBS). Subsequent cerebrospinal fluid (CSF) analysis identified unexpectedly high protein levels (attributable to Froin’s syndrome1) and magnetic resonance imaging (MRI) was highly suggestive of leptomeningeal carcinomatosis and cerebral metastases secondary to disseminated malignant melanoma. The disease progressed with rapid deterioration despite high dose corticosteroids and the patient died 12 days after admission.
This case brings several key points to the attention of the acute physician, in particular the need to give serious consideration to the differential diagnosis of cancer in a patient presenting with lower limb weakness.
[download-attachments container="div" style="list" dipslay_icon="1" display_count="1" display__size="0"]
References
- Mirza S, Adams WM, Corkhill RA. Froin's syndrome revisited, 100 years on; Pseudo-Froin’s on MRI. Clinical Radiology 2008; 63(5): 600–604.
- Winer J. Guillain-Barré syndrome. BMJ 2008; 337: 671.
- Eberth CJ. Zur Entwicklung des Epitheliomas (Cholesteatomas) dur Pia under der Lungs. Virchow’s Arch 1870; 49: 51–63.
- Grossman SA, Krabak US. Leptomeningeal carcinomatosis. Cancer Treat Rev 1999; 25: 103–109.
- Pavlidis N. The diagnostic and therapeutic management of leptomeningeal carcinomatosis. Ann Oncol 2004; 15(Supp 4): 285–291.
- Wolfgang G, Marcus D, Ulrike S. LC: clinical syndrome in different primaries. J Neurooncol 1998; 38(2-3): 103–10.
- Amer MH, Al Sarraf M, Baker LH et al. Malignant melanoma and central nervous system metastases. Cancer 1978; 42: 660–668.
- Chamberlain MC. Comparative spine imaging in leptomeningeal metastases. J Neurooncol 1995; 29: 233–238.
- Taillibert S, Laigle-Donadey F, Chodkiewicz C et al. Leptomeningeal metastases from solid malignancy: a review. J Neurooncol 2005; 75(1): 85–9.
Request Permissions
To request copyright permission to republish or share portions of our works, please visit Copyright Clearance Center’s (CCC) Marketplace website by clicking the button below:
