Tarlov cysts: symptoms, causes and treatment

Sometimes and due to certain types of organic abnormalities, our body produces and develops a series of abnormal masses formed by membranous sacs that house liquid substances or elements produced by the body itself. Although in most cases they do not pose a threat to the physical integrity of the person, their effects can be quite bothersome. This is the case with Tarlov cysts, Abnormal formations which may appear in the lumbar or sacral region.

Throughout this article, we’ll talk about the characteristics of these deformities, along with the symptoms associated with them, causes, and possible treatments.

    What are Tarlov cysts?

    Also diagnosed under the label of Perineural, periradicular or extradural arachnoid cystsTarlov cysts are small bodies and contain a small amount of cerebrospinal fluid inside.

    These cysts are formed by dilation of the dura mater, so they are classified as a pathology of it. These are abnormal formations which also have a rod or extension that keeps them connected to the spinal subarachnoid spaceAlso, locating around the nerves in the sacral and lumbar region that are pressed or compressed by these cysts.

    Although, as I just mentioned, Tarlov cysts usually affect the nerves located in the lower part of the spine, these abnormal bodies are completely asymptomatic in the first phase of their development. In other words, they should not lead to the appearance of symptoms that betray them.

    However, in cases where the person suffers from trauma or inflammation, or when the compression of the nerves is very severe, the patient may experience pain in the lower back areas. As well as symptoms of sciatica, urinary incontinence or headaches among many others which will be mentioned in the following point.

    These pathological formations of the dura mater, which they are named after the American neurosurgeon Isadore TarlovThey have a much higher incidence in women, and their symptoms can be alleviated by diet or an alkaline diet, among many other treatments.

    What are the symptoms?

    The main feature of Tarlov cysts is that they are usually asymptomatic, in at least 70% of people who have them. However, in other cases, they can be very boring.

    Due to the discretion with which they develop, they are most often discovered accidentally when the person has some type of neuroimaging test like a nuclear MRI and tend to be assessed as unimportant formations.

    In some cases, during the early stages of its formation, symptoms may appear that develop gradually or vice versa. a painful clinical picture, Suddenly. Likewise, the severity or intensity with which the symptoms affect the person will largely depend on the extent to which Tarlov cysts develop.

    In most patients, symptoms begin with a slight pain felt at the same level as the cyst, Followed by a series of alterations in all these organs or functions related to the nerve on which pressure is exerted.

    Although initially they do not pose a threat or danger to the physical health of the person, without effective treatment, Tarlov cysts can lead to very serious complications that seriously compromise the quality of life of the patient, which is likely to develop any type of dependence or physical disability. both partial and complete.

    Some of the main symptoms that may occur are:

    • Pain in the lower back or in the saber.
    • Sciatica.
    • Pain in the buttocks.
    • Pain in the hip.
    • muscle pain in the thighs due to decreased blood flow.
    • Complications in the excretory organs.
    • Alterations of the reproductive organs.
    • Decreased sensitivity or hypoaesthesia.
    • Tingling sensation or paresthesia.

    As a result, people with Tarlov cysts they have great difficulty performing certain movements or postures like standing or trying to sit. Likewise, walking, bending or falling asleep can be a great torment because of the painful sensations they cause.

    What are the causes?

    So far, it has not been possible to establish a completely reliable cause of Tarlov cysts. However, over time, different theories have developed, the main hypotheses relate these cysts to a traumatic, congenital and hemorrhagic origin.

    1. Congenital hypothesis

    This first theory brings out the idea that certain irregularities in the formation of the membranes surrounding the brain called meninges can be the main cause of the formation of these cysts; or a congenital alteration of the most superficial of these membranes, The duramater;

    2. Traumatic hypothesis

    On the other hand, the traumatic hypothesis describes that injuries caused by spinal punctures, anesthesia applied to the epidural area or the vertebral area, as well as trauma affecting the sacral area they can also be the cause of the appearance of these masses of cerebrospinal fluid.

    3. Hemorrhagic hypothesis

    As the name suggests, the hemorrhagic hypothesis is based on the case of the cyst it is produced by subarachnoid hemorrhage.

    How to diagnose it?

    As noted above, in most cases Tarlov cysts they are usually diagnosed accidentally when the person has some type of neuroimaging test carried out in the area where the masses are located.

    However, in cases where the person begins to experience the first symptoms it will be necessary to perform a functional MRI. Also, in order to rule out the possibility that it is another type of condition, you need to do a computerized myelography that reveals a connection between the cyst and the subarachnoid space.

    Is there a treatment?

    The choice of one of the possible treatments that exist for Tarlov cysts is subject to the type of effects and symptoms experienced by the patient, as well as the size of the cyst and the results of physical tests.

    In smaller cysts that don’t cause very significant or bothersome symptoms, the procedure is usually physiotherapy, combined with the administration of anti-inflammatory drugs or pain reliever. Recent studies have found that gabapentin, traditionally used to treat epilepsy and neuropathic pain, has been shown to be very effective in reducing the effects of cysts.

    However, in more severe cases, it is very possible that the patient will need to have surgery. Using a technique known as fenestration, the surgeon can puncture the cyst and drain the cerebrospinal fluid who’s in it. It is then sealed to avoid the possibility of liquid filling.

    Finally, a very effective treatment for relieving the pain of Tarlov cysts is transcutaneous electrical nerve stimulation. An intervention that has no side effects and consists of the application of small electrical currents through the skin.

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