Tuesday, July 28, 2009

Tarlov Cyst

25 year old young male came with radicular pain to lower limb on right side referred for MRI LS spine. MRI T2 weighted para saggital image shows well defined rounded hyperintense lesion in the D12-L1 intervertebral foramen causing compression on the exiting nerve root on right side. CISS 3D axial image shows the lesion better (arrow).

Tarlov or perineurial cysts are pathological formations located in the space between the peri-and endoneurium of the spinal posterior nerve root sheath. Tarlov cysts are rare causes of low back pain. They are more common in females. Clinical presentation of Tarlov cysts is variable. The cysts may cause local and/or radicular pain. Depending on their location, size and relationship to the nerve roots, they may cause sensory disturbances or motor deficits to the point of bladder dysfunction.

Radiograph is usually normal, it may show bony erosion or widening of foramen on oblique views. Conventional myelography may show extradural indentation on the thecal sac however MRI is needed for confirmation of the lesion. CT scan can demonstrate cystic lesion isodense with CSF located at the foramina. Bony changes may also be present. MRI shows welldefined CSF intensity lesion in the prineural location predominantly in lumbar and sacral region. The lesions may be seen in the cauda equina and other nerve roots.

1 comment:

A Virgin Tomorrow said...

My 13 year old son is a year round baseball player who plays at an elite highly competitive level. Since last summer he's been suffering from fairly severe back pain. xrays have revealed nothing particularly out of ordinary aside from a straightening of the spine. His disks and vertebrates are all the proper size, shape and alignment otherwise. The pain persists, radiating down his right leg and he has difficulty sitting for long periods of time. I was finally able to convince his doctor to refer him to a MRI. The results were "negative" according to the report and his orthopedic doctor signed off on the report. He has been prescribed physical therapy. Since I live with this child and witness his pain on a daily basis, I'm know something isn't right. I popped the MRI CD in the computer and I was FLOORED to discover that, plain as day, there is an obvious, well defined, bright white, round anomaly, located around his L5, precisely where his pain is, in four separate images. I did my best to describe what I saw in a Google search, and started finding MRIs with the identical image. They were consistently referred to as "tarlov cysts." It's very discouraging that the medical professionals could so easily overlook something so blatant. I have an appointment coming up next week to meet with is PC doctor to get a neurologist to make an official diagnosis. I'm praying.

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