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What is Tarlov Cyst or Perineural Cyst?
Perineural vesicle is a meningeal cystic sac which develops from meningeal covering of spinal nerve close to spinal cord . Perineural cyst is also cognize as Tarlov vesicle . Isadore Tarlov described the symptom of pinched face because of perineural vesicle in 1938 . The vesicle is more common and often seen in sacral segment of spinal corduroy . The vesicle in rare cases is also observed in neck , thoracic or lumbar segment of spinal cord . Tarlov vesicle or perineural cyst are located near dorsal root ganglion and vesicle is filled with cerebrospinal fluid . More than individual Tarlov Cyst is rarified but seldom seen in few cases . Asymptomatic Tarlov Cyst are watch over inCT ScanandMRIas an concomitant determination .
What is a Tarlov Cyst or Perineural Cyst on the Spine?
Tarlov cyst or perineural cyst are categorized into the listing of type II innervated meningeal cysts . The Tarlov Cyst or perineural cyst are filled with the cerebrospinal fluid ( CSF ) . Tarlov Cyst is most often see in sacral face and lies within lower lumbar or sacral spinal channel . Cyst is located at the fundament of the spinal face close to spinal cord . Thus the disease or symptomatic condition because of Tarlov Cyst is also known as Myelopathy or disease of spinal corduroy .
Causes of Tarlov Cyst or Perineural Cyst
The true causes of Tarlov Cyst or perineural vesicle formation is not yet well show in published enquiry data . The issue data of lab study and investigational data often elaborate the cause of Tarlov cyst as congenital , subaltern to kindling of spinal meningeal covering , induce by traumatic injury of spinal covering , hypertrophy or proliferation of spinal meninx and hemosiderin deposit over the meninges following trauma that follows proliferation of meninx . Inflammation of spinal meninx is diagnose as arachnoiditis . The unyielding local excitation of spinal anaesthesia covering like arachnoiditis have impuissance in covering of spinal meninges that may finally forge a Tarlov cyst.1As the sacs are filled with CSF , many researchers palpate that it has something to do with the unnatural communicating between the subarachnoid place containing CSF or cerebrospinal fluid and perineural region . Any increment in the CSF or cerebrospinal fluid insistency can fight CSF into meningeal covering of spinal nerve and force to form a cyst or pouch around watery meninges handle . Some study have reported that disorder in connective tissue make somebody more prone to Tarlov cyst or perineural cyst . Tarlov Cyst was identified as a cause of back pain and cauda equina syndrome in patient suffering with rare connective tissue disorder cognise asEhlers - Danlos Syndromes.2
Symptoms and Signs Caused by Tarlov Cyst
Neck, Thorax and Upper Lumbar segment
by and large , the disease is symptomless until the size of it of the tarlov cyst is turgid enough to make soreness or tweak of spinal nerve . Single prominent Tarlov Cysts more than 1 cm in diam can cause irritation or pinch of spinal nerve in neck opening , chest and upper lumbar segment . likewise , multiple Tarlov Cyst cause innervation or pinch of multiple spinal spunk . The irritation or pinch of receptive nerve causes symptoms like painfulness , paraesthesia , prickling and numbness . The pain symptom is also known as radicular pain when it spread out along the form of the nerve.3
Similarly , irritation or pinch of motor division of spinal nerve causes symptoms likespasticity , helplessness and segmental muscle palsy . In few suit large cyst may cause simultaneous irritation or collar of sensory and motor nerve fibers result in symptom like pain , numbness and weakness , which is also known asradiculopathy .
Symptoms and Signs Caused by Tarlov Cyst in Lower Lumbar and Sacral Segment
The spinal cord split up below the second lumbar vertebra into multiple bundle of 3 lumbar and 5 sacral nervousness known as cauda equina . Cauda equina mean parcel of nerve attend like quarter of the horse . The trace nerve fiber take form cauda equina- Lumbar third , 4th , fifth spunk and Sacral one , two , three , fourth and fifth nerves . The lumbar 3 nervousness ( L1 to and sacral first spunk S1 contains receptive and motor nerve character , while sacral nerves 2nd to 5th ( S2 , S3 , S4 and S5 ) arrest sensory , motor and parasympathetic autonomic nerves vulcanized fiber . The Tarlov Cyst of downhearted lumbar ( L3 to 5 ) and sacral nerve ( S1 to S5 ) lies within lower lumbar spinal epithelial duct . The cyst perpetually pose force per unit area on the neighboring nerves within cauda equina causing centripetal , motor and autonomic dysfunction and unnatural symptoms . These unnatural sensory , motor or autonomic symptoms are recognize as cauda equina syndrome.4Irritation or pinch of sensory nerve causes pain , tingling and numbness spread over back , perineum , buttocks , inguinal region and lower pegleg . The radicular pain is also known as sciatica when nuisance radiates along the back of the lower stage . The excitation or taking into custody of motor brass or nerve to muscleman have symptoms like piriformis muscle dysfunction , pelvic floor muscle dysfunction , heftiness helplessness in gluteal domain , seawall , and low wooden leg . The irritation or pinch of autonomic mettle causes neurogenic vesica , dysuria , bowel dysfunction , retrograde ejaculation , powerlessness and urinary incontinency . The combination of unnatural sensory , motor and autonomic symptom is known as cauda equina syndrome.5If the discourse for initial symptom like weakness in leg are not originate soon then individual may suffer with paralysis of leg muscles . Most of the caseful of Tarlov Cyst or perineural cyst remain undiagnosed , as there are no other symptoms . master and doctors can detect Tarlov Cyst or perineural vesicle only by using the imaging techniques or myelogram .
Can Tarlov Cyst or Perineural Cyst Cause Back Pain?
Tarlov vesicle or perineural cyst may be associated with the back pain . As the vesicle grows larger , the cyst engender atmospheric pressure over facet and sacroiliac joint resulting in back pain.6The back pain is also triggered by annoying of sensory and motor nerves , which are supplying sensorial and motor fibers to lower back . Irritation of these receptive and motor nerve fiber within spinal heart by Tarlov Cyst causes pain spread over paravertebral or gluteal muscle as well as gentle tissue of the blue back like hide and subcutaneous tissue . The degeneration of these sensational and motor spunk fibers are triggered by continuous pressure level and botheration by Tarlov Cyst . The irritation of motor fiber also causes paravertebral and gluteal muscles cramp or spasticity resulting in temperate to severe back painful sensation .
Diagnostic Tests for Tarlov Cyst or Perineural Cyst
There are few tests available for diagnose Tarlov Cyst or perineural cyst .
Radiological Studies – PlainX - Rayis not capable to nail the Tarlov Cyst in spinal canal . CT Scan and MRI often show incidental Tarlov Cyst when test is performed to diagnose the cause of back pain or sciatica . Most radiological investigational studies for back pain , radicular pain , spiritlessness and weakness in legs are perform to prevail out phonograph record hernia or bulge disc . These studies sometime show the cystic hump of Tarlov Cyst around the nervus root , which is further evaluate by EMG and Myelogram subject field .
Electromyography ( EMG ) Studies7 – The uninterrupted discomfort and pressing from large cyst have degeneration and damage of sensory and motor nerve . EMG studies are performed to judge the abnormalities bespeak legal injury nerve .
Myelography Studies – Myelography study involves injection of dyestuff in CSF and followed by CT Scan . Tarlov Cyst or Perineural vesicle in most cases do not show filling of dye in the cyst immediately following the procedure . One of the study suggests shot of Pantopaque and performing CT scan study after 3 to 4 day of injection of dye Pantopaque or in some case after 1 to 2 week may show dyestuff filing in the Tarlov Cyst.8
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