Tarlov cyst clinical features
Type II SMCs: most remain asymptomatic, although cases of positional coccydynia, sacral pain, and radiculopathy as well as sphincter disturbance have been reported. A ball-valve mechanism may be the mechanism of symptom production in some cases.
Studies suggest a possible association between Tarlov cysts (TCs), usually considered as incidental radiological findings, and neurological symptoms such as pain, numbness and urogenital complaints.
They are associated with injury to the sacral somatic innervation in the majority of patients with presumed symptomatic cysts. However, urinary incontinence is unlikely to be related to TC-induced nerve damage. 1).
Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by distressing, abnormal genitopelvic sensations, especially unwanted arousal. In a subgroup of patients with PGAD/GPD, cauda equina Tarlov cyst-induced sacral radiculopathy has been reported to trigger the disorder. In a evaluation of lumbosacral magnetic resonance images in patients with PGAD/GPD and suspected sacral radiculopathy, some had no Tarlov cysts but showed lumbosacral disc annular tear pathology 2).
Contrary to current understanding, TCs are associated with injury to the sacral somatic innervation in the majority of patients with presumed symptomatic cysts. However, urinary incontinence is unlikely to be related to TC-induced nerve damage 3).
Tarlov cysts presented with back pain and radicular pain after spontaneous SAH, with symptomatic relief following CT-guided aspiration of blood from the cyst. Spontaneous hemorrhage into the cyst may occur Symptoms of expanding/enlarging cysts occur due to compression of nerve roots that exit from the sacral area. Symptoms may include the following, dependent on the location of the cysts and the section of the spine they occur:
Pain in lower back (particularly below the waist) and in buttocks, legs, and feet
Pain in the chest, upper back, neck, arms and hands
Weakness and/or cramping in legs and feet / arms and hands
Paresthesias (abnormal sensations) in legs and feet or arms and hands, dependent on cyst locations
Pain sitting or standing for even short periods of time
Pain when sneezing or coughing
Inability to empty the bladder or in extreme cases to urinate at all requiring catheterization
Bowel or bladder changes, including incontinence
Swelling over the sacral (or cervical, thoracic, or lumbar) area of the spine
Soreness, a feeling of pressure and tenderness over the sacrum and coccyx (tailbone), extending across the hip and into the thigh with cysts in the sacrum. Same feelings in upper sections of the spine dependent on cyst locations
Headaches (due to the changes in the CSF pressure) and sometimes accompanied by blurred vision, double vision, pressure behind the eyes and optic nerve pressure causing papilledema (optic nerve swelling)
Other sensory system symptoms: Tinnitus/Ear noises (ringing, buzzing, snapping,popping, cricket sounds,etc.)
Dizziness and feeling of loss of balance or equilibrium, especially with change of position
The feeling of sitting on a rock
Pulling and burning sensation in coccyx (tailbone) area, especially when bending
Sciatica
Vaginal, rectal, pelvic and/or abdominal pain
Restless leg Syndrome
PGAD (Persistent Genital Arousal Disorder)
Sexual dysfunction and painful intercourse