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Tarlov Cyst


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]
  • To our knowledge, a lumbar Tarlov cyst presenting as a giant abdominal cyst in an infant has not been reported in the English-language literature.[ncbi.nlm.nih.gov]
  • The present case illustrates that clinicians caring for elderly patients with Marfan syndrome need to increasingly recognize such unusual late-life complications.[ncbi.nlm.nih.gov]
  • To guide appropriate diagnosis and treatment, we reviewed causes, clinical presentations, radiologic features, and management options of this extremely rare lesion.[ncbi.nlm.nih.gov]
  • We present a case of a 24-year-old patient who had uneventful spinal anaesthesia at the L3-4 level for an elective caesarean section.[ncbi.nlm.nih.gov]
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]
  • Lumbosacral pain, leg pain, and bowel and bladder dysfunction are common clinical complaints, while abdominal pain is uncommon. Myelography and magnetic resonance imaging are considered useful diagnostic techniques.[ncbi.nlm.nih.gov]
  • Preoperative symptoms include low back pain, coccydynia, buttock pain, perianal pain and radicular pain. All of the patients underwent surgical resection. The mean follow-up was 54 months (range 3-160 months).[ncbi.nlm.nih.gov]
  • We present here a case of cervical perineural cysts with persistent radicular pain where the pain was adequately managed with repetitive transforaminal epidural steroid injection (TFESI).[ncbi.nlm.nih.gov]
Infertility
  • 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]
  • During an obstetric investigation for infertility, the clinician discovered a huge presacral cystic mass.[ncbi.nlm.nih.gov]
  • "Tarlov Cyst and Infertility". J Spinal Cord Med. 32 (2): 191–197. PMC 2678291. PMID 19569467. Nishiura I, Koyama T, Handa J (1985). "Intrasacral perineural cyst". Surg Neurol. 23 : 265–269. doi : 10.1016/0090-3019(85)90093-x.[en.wikipedia.org]
Lower Abdominal Pain
  • abdominal pain Interstitial cystitis Weakness in the extremities Swelling in the sacral area Soreness or tenderness in the area Headaches resulting from changes in spinal fluid pressure Dizziness or balance issues Restless leg syndrome Sexual dysfunction[marijuanadoctors.com]
  • abdominal pain, bowel dysfunction, intestinal motility disorders like constipation or bowel incontinence.[en.wikipedia.org]
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]
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]
Buttock Pain
  • Preoperative symptoms include low back pain, coccydynia, buttock pain, perianal pain and radicular pain. All of the patients underwent surgical resection. The mean follow-up was 54 months (range 3-160 months).[ncbi.nlm.nih.gov]
  • Preoperative symptoms include low back pain, coccydynia, buttock pain, perianal pain and radicular pain. All of the patients underwent surgical resection. The mean follow-up was 54 months (range 3–160 months).[link.springer.com]
  • For instance, the dominant symptom of a sacral perineural cyst is referable to the caudal nerve roots, either sciatica, sacral or buttock pain, vaginal or penile paraesthesia or sensory changes over the buttocks, perineal area and lower extremity 8.[ncbi.nlm.nih.gov]
  • The dominant syndrome is referable to the caudal nerve roots, either sciatica, sacral or buttocks pain, vaginal or penile paraesthesia or sensory changes over the buttocks, perineal area and lower extremity.[webmedcentral.com]
  • pain, vaginal or penile paraesthesia, Persistent Genital Arousal Disorder (PGAD) characterized by unwanted, unrelenting genital sensory awareness, itch or pain that can persist for days, months, even years) [19] , sensory changes over buttocks, perineal[en.wikipedia.org]
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]
Leg Cramp
  • The website provides information about symptomatic Tarlov cysts, which may cause such symptoms as sciatica, difficulty sitting or standing for more than short periods of time, coccyx (tailbone) pain, pain in buttocks and legs, leg cramps, paresthesias[web.archive.org]
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]
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]
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]
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]
  • "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]
  • “Because Tarlov cysts can affect the nerves, symptoms relating to loss of neurological function can also develop including leg weakness, diminished reflexes, loss of sensation on the skin, and changes in bowel or bladder function such as incontinence[rarediseaseday.org]
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]
  • dysfunction Pulling and burning feeling in the tailbone Loss of reflexes If you have a Tarlov cyst, the following may cause it to become painful or cause other symptoms: Traumatic injury such as a fall, automobile accident Heavy lifting Childbirth Epidural[winchesterhospital.org]
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]
  • 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]
  • 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]
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]
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]
  • 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]
  • 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 website provides information about symptomatic Tarlov cysts, which may cause such symptoms as sciatica, difficulty sitting or standing for more than short periods of time, coccyx (tailbone) pain, pain in buttocks and legs, leg cramps, paresthesias[web.archive.org]
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]
  • 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]
  • […] 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]
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]
Involuntary Movements
  • Painless legs and moving toes syndrome is a very rare syndrome characterized by continuous and involuntary movement of the toes.[ncbi.nlm.nih.gov]
Foot Drop
  • 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]

Treatment

  • Two patients who received conservative treatment continued to experience their presenting symptoms, whereas 7 patients who underwent surgical treatment experienced favorable outcomes.[ncbi.nlm.nih.gov]
  • 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]
  • Several authors recommend surgical treatment of symptomatic Tarlov cysts. However, successful surgical treatment is dependent on appropriate patient selection.[doi.org]
  • […] so that no further treatments were required.[dx.doi.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]
  • Giant cystic schwannoma of the sacrum is a very rare diagnosis overlooked by practitioners for more common cystic etiologies, but its treatment is significantly different.[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]
Sex distribution
Age distribution

Pathophysiology

  • Sacral nerve root cysts: a review on pathophysiology.[doi.org]
  • The cause, pathological features, and pathophysiological characteristics, clinical presentation, MRI results, treatment options, surgical indication, and microsurgical techniques are discussed.[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

  • 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]
  • Postoperative lumbar drainage to prevent CSF leak was also not adopted.[dx.doi.org]
  • There are no current guidelines to prevent a Tarlov cyst.[winchesterhospital.org]

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