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Indian Journal of Orthopaedics Oct 2007We describe a case of sacral perineural cyst presenting with complaints of low back pain with neurological claudication. The patient was treated by laminectomy and...
We describe a case of sacral perineural cyst presenting with complaints of low back pain with neurological claudication. The patient was treated by laminectomy and excision of the cyst. Tarlov cysts (sacral perineural cysts) are nerve root cysts found most commonly in the sacral roots, arising between the covering layer of the perineurium and the endoneurium near the dorsal root ganglion. The incidence of Tarlov cysts is 5% and most of them are asymptomatic, usually detected as incidental findings on MRI. Symptomatic Tarlov cysts are extremely rare, commonly presenting as sacral or lumbar pain syndromes, sciatica or rarely as cauda equina syndrome. Tarlov cysts should be considered in the differential diagnosis of patients presenting with these complaints.
PubMed: 21139800
DOI: 10.4103/0019-5413.37007 -
Cureus Aug 2022Uterine fibroids are common, especially among women of African descent. Several women with fibroids are asymptomatic, which may contribute to underestimating its...
Uterine fibroids are common, especially among women of African descent. Several women with fibroids are asymptomatic, which may contribute to underestimating its prevalence. Symptomatic uterine fibroids present with menstrual problems, anemia, infertility, miscarriages, an enlarged abdomen, pressure symptoms involving the bladder and bowels (such as frequent urination or constipation), and sometimes coital-related problems. This case report describes a 25-year-old African American woman with uterine fibroids who suffered from lower back pain radiating to the left lower extremity, along with paresthesias and weakness of the left leg. She was diagnosed with lumbar radiculopathy, early pregnancy, and an incidental finding of a Tarlov cyst. As the pregnancy progressed, the sciatic pain ceased within the first trimester. Sciatic pain can result from a sudden increase in the uterus size caused by an early pregnancy coexisting with large fibroids. The sciatic pain may not remain throughout the pregnancy as the growing uterus with large fibroids may be displaced from the site of nerve compression.
PubMed: 35968245
DOI: 10.7759/cureus.27855 -
Radiology Case Reports Feb 2021Subarachnoid fat is an uncommon finding that has several etiologies. It is important to determine the etiology in order to plan appropriate treatment. We present a case...
Subarachnoid fat is an uncommon finding that has several etiologies. It is important to determine the etiology in order to plan appropriate treatment. We present a case report of an 80-year-old female brought to the emergency department after a fall with complaints of headache and pain in the sacral region. Computed tomography and magnetic resonance images of the head demonstrated fat in the subarachnoid space. Computed tomography and magnetic resonance images of the sacrum demonstrated a Tarlov cyst with a sacral fracture extending into the cyst, likely representing the origin of the fat in the subarachnoid space. This case demonstrates a rare etiology of fat in the subarachnoid space.
PubMed: 33299505
DOI: 10.1016/j.radcr.2020.10.056 -
Journal of Medical Case Reports Mar 2016Painless legs and moving toes syndrome is a very rare syndrome characterized by continuous and involuntary movement of the toes. The etiology of the disease is not clear...
BACKGROUND
Painless legs and moving toes syndrome is a very rare syndrome characterized by continuous and involuntary movement of the toes. 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. A previous study has reported bilateral painful legs and moving toes syndrome in a patient with a sacral Tarlov cyst. In this report we present a case of unilateral painless legs and moving toes syndrome in a woman with a sacral Tarlov cyst.
CASE PRESENTATION
A 50-year-old Mediterranean woman presented with a 1-year history of involuntary sustained movement of her right toes. Her physical examination and laboratory findings did not show any remarkable abnormality. Her lumbosacral magnetic resonance imaging scan showed a sacral Tarlov cyst. Our patient was given gabapentin, 100 mg per day as a starting dose, and showed modest improvement. Our patient preferred not to continue with the treatment as her symptoms were not disabling and she was only concerned about the cosmetic appearance.
CONCLUSIONS
This report presents a new case of a very rare syndrome called painless legs and moving toes syndrome, which is possibly a variant of painful legs and moving toes syndrome. This is considered to be the first case of unilateral painless legs and moving toes syndrome that is associated with a sacral Tarlov cyst. Although the disease etiology is still unknown and the presence of the cyst can be accidental, neurologists should be aware that Tarlov cyst is a possible cause. In addition, patients with the painless variant who are not disabled by movement of the toes may not require treatment.
Topics: Amines; Antiparkinson Agents; Cyclohexanecarboxylic Acids; Dyskinesias; Female; Gabapentin; Humans; Leg; Magnetic Resonance Imaging; Middle Aged; Pain; Radiculopathy; Sacrum; Syndrome; Toes; Treatment Outcome; gamma-Aminobutyric Acid
PubMed: 26956999
DOI: 10.1186/s13256-016-0846-2 -
Pain Reports 2020Persistent genital arousal (PGAD) is a syndrome of unprovoked sexual arousal/orgasm of uncertain cause primarily reported in female patients. Most patients are referred...
INTRODUCTION
Persistent genital arousal (PGAD) is a syndrome of unprovoked sexual arousal/orgasm of uncertain cause primarily reported in female patients. Most patients are referred for mental-health treatment, but as research suggests associations with neurological symptoms and conditions, there is need to analyze cases comprehensively evaluated by neurologists.
METHODS
The IRB waived consent requirements for this retrospective university-hospital study. We extracted and analyzed neurological symptoms, test, and treatment results from all qualifying participants' records and recontacted some for details.
RESULTS
All 10 participants were female; their PGAD symptoms began between ages 11 to 70 years. Two patterns emerged: 80% reported daily out-of-context sexual arousal episodes (≤30/day) that usually included orgasm and 40% reported lesser, often longer-lasting, nonorgasmic arousals. Most also had symptoms consistent with sacral neuropathy-70% had urologic complaints and 60% had neuropathic perineal or buttock pain. In 90% of patients, diagnostic testing identified anatomically appropriate and plausibly causal neurological lesions. Sacral dorsal-root Tarlov cysts were most common (in 4), then sensory polyneuropathy (2). One had spina bifida occulta and another drug-withdrawal effect as apparently causal; lumbosacral disc herniation was suspected in another. Neurological treatments cured or significantly improved PGAD symptoms in 4/5 patients, including 2 cures.
CONCLUSIONS
Although limited by small size and referral bias to neurologists, this series strengthens associations with Tarlov cysts and sensory polyneuropathy and suggests new ones. We hypothesize that many cases of PGAD are caused by unprovoked firing of C-fibers in the regional special sensory neurons that subserve sexual arousal. Some PGAD symptoms may share pathophysiologic mechanisms with neuropathic pain and itch.
PubMed: 32072096
DOI: 10.1097/PR9.0000000000000801 -
Spinal Cord Series and Cases Aug 2022Cauda equina syndrome (CES) is most caused by lumbar disc herniation, and the associated treatment involves prompt surgical decompression. Rarer causes of CES include...
INTRODUCTION
Cauda equina syndrome (CES) is most caused by lumbar disc herniation, and the associated treatment involves prompt surgical decompression. Rarer causes of CES include perineural (Tarlov) cysts.
CLINICAL PRESENTATION
A 62-year-old female with history of rheumatoid arthritis, hip and knee replacements, and chronic low back pain presented with worsening back pain, left leg weakness and pain for 6 weeks, and bowel/bladder incontinence with diminished sensation in the perianal region for 24 h prior to presentation. MRI demonstrated severe spinal stenosis at L4-S1, central disc herniation at L5-S1, and compression of the cauda equina, consistent with CES. A lumbar decompression was performed. Patient did well at 2-week follow up, but presented 5 weeks post-discharge with increased left leg pain/weakness and genitalia anesthesia. Imaging was unremarkable. Two months later, the patient presented with diminished sensation in the buttocks and bilateral lower extremities and bowel/bladder incontinence. Imaging demonstrated a large cystic presacral mass with involvement of the left sciatic foramen and S3 neural foramen. A team of plastic, orthopedic, and neurological surgeons performed an S3 sacral laminectomy, foraminotomy, partial sacrectomy, and S3 rhizotomy, and excision of the large left hemorrhagic pudendal mass. Final pathology demonstrated a perineural cyst with organizing hemorrhage. On follow-up, the patient's pain and weakness improved.
CONCLUSION
CES-like symptoms were initially attributed to a herniated disk. However, lumbar decompression did not resolve symptoms, prompting further radiographic evaluation at two separate presentations. This represents the first reported case of a pudendal tumor causing symptoms initially attributed to a herniated disc.
Topics: Aftercare; Cauda Equina Syndrome; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Middle Aged; Neoplasms; Pain; Patient Discharge; Radiculopathy
PubMed: 35918325
DOI: 10.1038/s41394-022-00537-3 -
Neurological Sciences : Official... Sep 2013Tarlov cyst syndrome is a rare, often asymptomatic disorder, characterised by isolated or multiple nerve-root cysts, usually occurring in the sacral spine, near the...
Tarlov cyst syndrome is a rare, often asymptomatic disorder, characterised by isolated or multiple nerve-root cysts, usually occurring in the sacral spine, near the dorsal root ganglion, between the perineurium and endoneurium. The cysts may cause lower back pain, sacral radiculopathy, dyspareunia and urinary incontinence. There is little data in the literature on the relationship between Tarlov cysts and symptoms. Here, we report further details on the clinical impact of Tarlov cysts and investigate their pathogenesis and role as a cause of lumbosacral symptoms. We examined 157 patients with MRI evidence of symptomatic Tarlov cysts. Patients underwent complete neurological examination and were scored by the Hamilton Depression Rating Scale and the Visual Analogue Scale. Complete lower limb electromyography was performed in 32 patients. Clinical picture was correlated with size and number of cysts detected by MRI. Family history was recorded for signs of genetic inheritance. Almost all patients suffered perineal or lower back pain; 34 complained of sphincter and 46 of sexual disorders. Hamilton scores were abnormal, and family history was positive in a few cases. The scanty literature on Tarlov cysts mainly regards therapy by a neurosurgical approach. Our results provide new data on clinical impact and possible pathogenetic mechanisms.
Topics: Adult; Aged; Cohort Studies; Female; Humans; Italy; Male; Middle Aged; Tarlov Cysts; Young Adult
PubMed: 23400656
DOI: 10.1007/s10072-013-1321-0 -
Asian Journal of Surgery Dec 2023
Topics: Female; Humans; Cysts; Neck; Tarlov Cysts; Uterine Cervical Neoplasms; Middle Aged
PubMed: 37679203
DOI: 10.1016/j.asjsur.2023.08.155 -
Cureus Jul 2022Giant Tarlov cysts are described as fluid-filled sacs located in the spine. They are mostly found in the sacral region, but are usually asymptomatic. The symptomatic...
Giant Tarlov cysts are described as fluid-filled sacs located in the spine. They are mostly found in the sacral region, but are usually asymptomatic. The symptomatic Tarlov cysts are planned for surgical treatment in the form of laminectomy and marsupilisation of cysts. These surgical procedures can have complications like cerebrospinal fluid (CSF) leak, bacterial meningitis, and radiculopathic pain. We report a case of a 30-year-old male who presented with complaints of pain in his left leg for one and half years, urinary incontinence off and on for six months, and scrotal pain for two months. He was diagnosed with two giant Tarlov cysts on contrast-enhanced magnetic resonance imaging and planned for surgery. Intraoperatively, approximately 1000 ml of CSF was drained. The patient complained of severe headache in the immediate postoperative period, which was confirmed to be a low-CSF pressure headache. Prompt diagnosis and management with collaborative teamwork of neuroanesthetists and neurosurgeons helped treat the patient and prevent long-term morbidity.
PubMed: 35989763
DOI: 10.7759/cureus.27045 -
Cureus Jan 2018Perineural cysts are cystic dilations and are frequently seen in relation to the lumbosacral spine. We describe a case of a fifth lumbar (L5) perineural cyst with...
Perineural cysts are cystic dilations and are frequently seen in relation to the lumbosacral spine. We describe a case of a fifth lumbar (L5) perineural cyst with unusual radicular symptoms and discuss the possible role of traction plexopathy caused by the cyst. A 38-year-old male presented with a longstanding history of back pain and right side thigh pain. This pain radiated from the buttocks to the lateral and anterior aspect of the thigh. He described the pain as pins and needles/burning with no significant relief with medications or rest. Imaging of the lumbar spine revealed a cystic lesion on the right side involving the L5 nerve root in the foraminal region. He failed conservative treatment and elected to have the cyst removed even with a guarded prognosis. A wide L5 laminectomy was performed. Due to the size of the cyst which was causing traction on the exiting L5 nerve root, the L5 pedicle was excised in order to delineate the cyst and to prevent any iatrogenic injury to the root. The patient had the dramatic improvement in his radicular pain immediately after the surgery and continues to be pain-free at his latest three-year follow-up. This case highlights the unusual pain pattern distribution from a perineural cyst possibly secondary to traction effect of the tumor.
PubMed: 32175195
DOI: 10.7759/cureus.2052