Presentation
In this report we present a case of unilateral painless legs and moving toes syndrome in a woman with a sacral Tarlov cyst. A 50-year-old Mediterranean woman presented with a 1-year history of involuntary sustained movement of her right toes. [ncbi.nlm.nih.gov]
Entire Body System
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Pain
Prognosis In some instances Tarlov cysts can cause nerve pain and other pain, weakness, or nerve root compression. Acute and chronic pain may require changes in lifestyle. [ninds.nih.gov]
In some instances Tarlov cysts can cause nerve pain and other pain, weakness, or nerve root compression. Acute and chronic pain may require changes in lifestyle. If left untreated, nerve root compression can cause permanent neurological damage. [web.archive.org]
Immediately after surgery, the patient had no leg pain. After 6 months, the patient still remained free of leg pain. [ncbi.nlm.nih.gov]
Additionally, many patients had generalized sacral and/or lumbar pain; pelvic and/or perineal pain; and sexual, bladder, or bowel dysfunctions. [dx.doi.org]
Gastrointestinal
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Explosive Diarrhea
This 67-year-old Caucasian female presented with progressively severe pelvic pain, intermittent explosive diarrhea, and dysuria. Physical and bimanual examination demonstrated genital prolapse and a nontender, cyst-like mass fixed in the midline. [ncbi.nlm.nih.gov]
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Severe Abdominal Pain
These cysts, though rare, can be found to grow large - over 3–4 centimetres (1.2–1.6 in) in size, often causing severe abdominal pain from compression on the cyst itself as well as adjoining nerves. [en.wikipedia.org]
Musculoskeletal
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Foot Pain
Sacral cysts have been reported to cause sacral radiculopathy, hip, leg or foot pain, perineal pain, paresthesias, and bowel or bladder dysfunction. Symptoms can mimic a disc herniation. There are many variations of Tarlov cysts. [dynamicchiropractic.com]
Anterior cysts ( with pudendal nerve entrapment) may react more than posterior ones, but posterior cysts also respond (foot pain, leg numbness, muscle weakness, etc.). [causes.com]
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Acute Low Back Pain
Acute low back pain is a very common symptom and reason for many medical consultations. In some unusual circumstances it could be linked to a rare aetiology. [ncbi.nlm.nih.gov]
Psychiatrical
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Withdrawn
So withdrawn. So helpless.… [corinanielsen.com]
Both needles were then withdrawn, and the puncture sites were covered with an antibiotic ointment and a sterile dressing. Patients were observed for 2 hours after the completion of the procedure before being discharged. [dx.doi.org]
Face, Head & Neck
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Wide Neck
However, when symptoms develop that are suggestive of TCs, MRI will demonstrate their presence, and Myelogram or CT may demonstrate the CSF flow between the spinal subarachnoid area and the cyst, determining how rapidly the open communicating/wide neck [tarlovcystfoundation.org]
All patients with cystic abnormalities other than perineurial cysts and patients with cysts possessing considerable (wide-neck) direct communication with the subarachnoid space were rejected. [dx.doi.org]
Neurologic
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Sciatica
Information from the National Library of Medicine’s MedlinePlus Sciatica [ninds.nih.gov]
The initial symptoms were low back pain and sciatica and progressed to cauda equina syndrome. Surgical treatment was performed by sacral laminectomy and wide cyst fenestration. [ncbi.nlm.nih.gov]
Symptomatic Tarlov cysts are extremely rare, commonly presenting as sacral or lumbar pain syndromes, sciatica or rarely as cauda equina syndrome. [ijoonline.com]
Diagnostic methods Diagnosis is based on magnetic resonance imaging (MRI), computed topography (CT) or myelogram of patients experiencing lower back pain or sciatica. [orpha.net]
The Tarlov Cyst as it enlarges or presses on other nerves can cause back pain, sciatica, pain on standing, walking and sometimes difficulty emptying the bladder and bowel. [axappphealthcare.co.uk]
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Hypesthesia
The hypesthesia persisted, as did the right leg pain. Cyst-subarachnoid shunt was set to decompress nerve root and to equalize the cerebrospinal fluid pressure between the cephalad thecal sac and cyst. [ncbi.nlm.nih.gov]
[…] dysfunction with tertiary sciatica, Cauda equina syndrome, neurogenic claudication (pain caused by walking), neurogenic bladder, dysuria, urinary incontinence, coccygodynia, sacral radiculopathy, radicular pain, headaches, retrograde ejaculation, paresthesia, hypesthesia [en.wikipedia.org]
Patients have expressed common symptoms, such as: Back and perineal pain Urinary incontinence Sciatica Dysuria Radicular pain Headaches Retrograde ejaculation Parasthesia, or abnormal sensations in the extremities Hypesthesia Difficulty walking Severe [marijuanadoctors.com]
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Absent Ankle Reflex
The most common physical neurologic abnormality observed in our patients was an absent ankle reflex. Weakness of plantar flexion was also prevalent, as were cyst-related sensory loss, reduced rectal sphincter tone, and bladder sphincter impairment. [dx.doi.org]
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Foot Drop
Foot drop and atrophy of the foot muscles Motor neuron symptoms are less frequently observed in patients with STCs. [omicsonline.org]
Additional symptoms have been reported in the medical literature including chronic headaches, blurred vision, pressure behind the eyes, dizziness, and dragging of the foot when walking due to weakness of the muscles in the ankles and feet (foot drop). [rarediseases.org]
Urogenital
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Incontinence
These cysts (also known as meningeal or perineural cysts) can compress nerve roots, causing lower back pain, sciatica (shock-like or burning pain in the lower back, buttocks, and down one leg to below the knee), urinary incontinence, headaches (due to [ninds.nih.gov]
Symptoms sometimes caused by Tarlov cysts include pain in the area served by the affected nerves, numbness and altered sensation, an inability to control bladder and bowel movements (incontinence), impotence, and, rarely, weakness in the legs. [chiarigear.com]
He reported that mild fecal incontinence was common in his patients [ 7 ]. [omicsonline.org]
"Case 7-2013: A 77-year-old woman with long-standing unilateral thoracic pain and incontinence". New England Journal of Medicine. 368 : 853–861. doi : 10.1056/NEJMcpc1114034. [en.wikipedia.org]
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Sexual Dysfunction
dysfunction, and some loss of feeling or control of movement in the leg and/or foot. [ninds.nih.gov]
In some patients, however, it appears that Tarlov cysts are the cause of symptoms, such as pelvic or perineal pain/discomfort, sphincter/sexual dysfunction, radicular pain/numbness and neurogenic claudication 3,6. [radiopaedia.org]
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Retrograde Ejaculation
To the best of our knowledge, this is the first reported case of Tarlov cyst associated with retrograde ejaculation and infertility. [ncbi.nlm.nih.gov]
ejaculation, paresthesia, hypesthesia, secondary pelvic floor dysfunction, vaginismus, motor disorders in lower limbs and the genital, perineal, or lumbosacral areas, sacral or buttocks pain, vaginal or penile paraesthesia, Persistent Genital Arousal [en.wikipedia.org]
Patients have expressed common symptoms, such as: Back and perineal pain Urinary incontinence Sciatica Dysuria Radicular pain Headaches Retrograde ejaculation Parasthesia, or abnormal sensations in the extremities Hypesthesia Difficulty walking Severe [marijuanadoctors.com]
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Adnexal Mass
This case report describes the clinical course after biopsy of a very large Tarlov cyst via laparoscopy, which was thought preoperatively to be an adnexal mass. It serves as a warning against attempting biopsy or resection of these lesions. [ncbi.nlm.nih.gov]
Workup
After addressing the other problem, which was temporary, he did a total neurological workup in which he found that I had no reflexes in my legs. [pinecreekmedicalcenter.com]
Treatment
[…] so that no further treatments were required. [dx.doi.org]
Several authors recommend surgical treatment of symptomatic Tarlov cysts. However, successful surgical treatment is dependent on appropriate patient selection. [doi.org]
Only some of the symptomatic cysts warrant treatment. The authors describe the successful operative treatment of a patient with, to the best of their knowledge, the largest perineural cyst reported to date. [ncbi.nlm.nih.gov]
In our series there were two patients who refused surgical treatment. [dx.plos.org]
Prognosis
Prognosis In some instances Tarlov cysts can cause nerve pain and other pain, weakness, or nerve root compression. Acute and chronic pain may require changes in lifestyle. [ninds.nih.gov]
What is the prognosis? In some instances Tarlov cysts can cause nerve pain and other pain, weakness, or nerve root compression. Acute and chronic pain may require changes in lifestyle. [web.archive.org]
Treatment and prognosis In asymptomatic individuals no treatment or further investigation is necessary. This accounts for the vast majority of Tarlov cysts. [radiopaedia.org]
Prognosis Those who have progressive and prolonged symptoms may experience neurological damage if the cysts continue to compress nerve structures. [orpha.net]
Prognosis of Symptomatic Tarlov Cysts Those who have progressive and prolonged symptoms run a risk of neurological damage, if the cysts continue to compress nerve structures. [tarlovcystfoundation.org]
Etiology
The etiology of the disease is not clear though it has been linked to a wide range of neuronal insults including proximal root compression and neuropathy. [ncbi.nlm.nih.gov]
The etiology of perineural sacral cysts (Tarlov's cysts) is not well-understood. The best description is that they are a dilatation of arachnoid and dura of spinal posterior nerve-root sheath, containing nerve fibers. [dynamicchiropractic.com]
“In seeking the etiology and treatment for PGAD for a sufferer, it would seem advisable to test for – at the very least to rule out – Tarlov cysts,” they wrote. [issm.info]
Etiology There are a number of conditions that can cause the cysts to become symptomatic, including traumatic injury, heavy lifting, childbirth, epidurals, and trauma to the spinal cord. [orpha.net]
Epidemiology
Summary Epidemiology The annual incidence of perineural cysts is estimated at approximately 5%, although large cysts that cause symptoms are relatively rare with annual incidence estimated at less than 1/2,000. [orpha.net]
Epidemiology About 95% of the respondents are female and 5% are males. The gender distribution among this group may reflect users of Tarlov Cyst support group rather than the actual distribution of TC within a population. [braintalkcommunities.org]
Epidemiologic data were collected and the type, number, and location of the meningeal cysts in each patient were determined on magnetic resonance imaging. [ncbi.nlm.nih.gov]
Pathophysiology
Sacral nerve root cysts: a review on pathophysiology. [doi.org]
Treatment [ edit ] Because of the unclear pathogenesis and pathophysiology of Tarlov cysts, there is no consensus on the optimal treatment of symptomatic sacral perineural cysts. [en.wikipedia.org]
Prevention
Postoperative lumbar drainage to prevent CSF leak was also not adopted. [dx.plos.org]
Familiarizing physicians with this unusual presentation of Tarlov cyst may help them in early recognition of this lesion, and subsequent surgery might be considered to prevent clinical sequela. [ncbi.nlm.nih.gov]
There are no current guidelines to prevent a Tarlov cyst. [winchesterhospital.org]