Theorem. Every finitely presentable group is the fundamental group of a closed 4-manifold.
Sketch proof. Let langlea1,ldots,ammidr1,ldots,rnrangle be a presentation. By van Kampen, the connected sum of m copies of S1timesS3 has fundamental group isomorphic to the free group on a1,ldots,am. Now we can quotient by each relation rj as follows. Realise rj as a simple loop. A tubular neighbourhood of this looks like S1timesD3. Do surgery and replace this tubular neighbourhood with S2timesD2. This kills rj. QED
There are many restrictions on 3-manifold groups. One of the simplest arises from the existence of Heegaard splittings. It follows easily that if M is a closed 3-manifold then pi1(M) has a balanced presentation, meaning that nleqm.
Other obstructions to being a 3-manifold group were discussed in this MO question.
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