Diagnosis: Tarlov cyst - SocialEasator

Tarlov cyst (perineurial cysts) is a cyst that occurs in the area of the spinal canal at the level of vertebrae S1 to S4 (1st to 4th sacral vertebra) and is filled with cerebrospinal fluid. Less commonly, it appears in the cervical, thoracic, or lumbar regions of the spine. These cysts are named after neurologist Isadore M. Tarlov, who described them as early as 1938.

Tarlov cysts are relatively common compared to other neurological cysts and are usually asymptomatic. They are often discovered incidentally during MRI or CT examinations performed for other health issues. The wall of a Tarlov cyst is thin and fibrous, making it prone to rupture upon contact; therefore, surgical removal is relatively complex, and specialists recommend surgery only in rare and severe cases. A Tarlov cyst can cause pain of varying intensity or nerve compression. The intensity of symptoms depends on the cyst’s location and size. Asymptomatic cysts may progress, enlarge, and pain may increase in intensity. A Tarlov cyst is not a genetic syndrome; it is a disorder of the nervous system.

Cause:

TC is not a genetic syndrome; it is a disorder of the nervous system. The exact cause of TC is unknown. Some theories point to TC as the result of an inflammatory process of the nerve roots or a post‑traumatic process that causes cerebrospinal fluid to leak into an area where a cyst then forms. According to some studies, TC is the result of an abnormal congenital communication between the subarachnoid space — where cerebrospinal fluid naturally resides — and the area surrounded by nerve fibers (the perineurial area). This communication eventually closes off, and a cyst subsequently forms.

Symptoms:

Tarlov cysts are often asymptomatic. They may grow and eventually cause compression or pressure on the nerve roots (radiculopathy). The intensity of symptoms is individual and depends on the size and location of the cyst. Most commonly, they cause chronic pain. Lumbosacral cysts cause pain in the sacral area, especially below the waist; the pain may radiate into the buttocks or the lower limb. The pain may intensify during walking (neurogenic claudication). Symptoms may worsen over time. Some patients describe pain especially when sitting or standing, while lying down may relieve the pain. In cases where the cyst is located higher in the spine, pain is described in the thoracic spine, neck, shoulders, and arms. The pain worsens with coughing or sneezing. Pain in the genital area, scrotum, pelvis, or abdomen is also described.

Other symptoms include loss of function of the neurons being compressed — such as weakness of the limbs, absence of neurological reflexes in the area innervated by the affected nerve, loss of sensation, changes in bowel emptying, or urinary dysfunction such as incontinence or painful urination (dysuria). Some patients report an inability to urinate or constipation. Sexual dysfunction, such as impotence, may also occur.

The literature also describes chronic headaches, blurred vision, pressure‑like pain in the eyes, dizziness, and dragging of the leg due to muscle weakness.

Diagnosis:

The two most commonly used and effective imaging methods for examining a Tarlov cyst are MRI and CT.

Treatment:

There are many treatment options to alleviate symptoms caused by these cysts, but their effectiveness is debatable. However, if nerve compression occurs, it is appropriate to consider surgical treatment. Initially, analgesic therapy is used, and possibly cyst aspiration, although this procedure may also have undesirable effects. It is important for these cysts to be monitored by the local neurologist, who, if necessary, will refer the patient for a neurosurgical consultation to determine whether surgery should be performed.

Tarlov cyst

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