Tarlov cysts can contribute to peripheral neuropathy, a condition affecting nerves outside the brain and spinal cord. While many individuals live with these cysts asymptomatically, a subset can experience symptoms. When these cysts expand, they may exert pressure on nearby nerve roots, leading to a range of issues. Understanding both conditions helps clarify their connection and impact on well-being.
Understanding Tarlov Cysts
Tarlov cysts, also known as perineural cysts, are fluid-filled sacs that form on spinal nerve roots, most commonly found in the sacral region at the base of the spine. These cysts are filled with cerebrospinal fluid (CSF), the fluid surrounding the brain and spinal cord. A distinguishing feature is the presence of nerve fibers within their walls or cavity, differentiating them from other spinal cysts. While the exact cause of Tarlov cysts is not fully understood, theories suggest they may result from trauma, inflammation, or increased cerebrospinal fluid pressure. They are often discovered incidentally during imaging, as approximately 70-95% of individuals remain asymptomatic.
Understanding Peripheral Neuropathy
Peripheral neuropathy describes damage to the peripheral nerves, a network connecting the brain and spinal cord to the body. These nerves transmit sensory information, control muscle movement, and regulate involuntary bodily functions. When peripheral nerves are damaged, this communication is disrupted.
Symptoms of peripheral neuropathy can vary widely depending on which nerves are affected, including sensations of numbness, tingling, or prickling, often starting in the hands and feet and potentially spreading. Individuals might also experience sharp, burning, or throbbing pain, muscle weakness, or a reduced ability to feel temperature changes or touch, as it can impact motor, sensory, or autonomic nerves, leading to diverse symptoms.
The Interplay: How Cysts Affect Nerves
Tarlov cysts can cause peripheral neuropathy when they enlarge and compress or irritate nerve roots within the spinal canal. This compression often occurs in the sacral spine, where these cysts are most common. Increased fluid pressure within the cyst can directly impinge on nerve fibers within the cyst wall or adjacent nerve roots. This mechanical pressure can disrupt the normal signaling of these nerves, resulting in neuropathic symptoms.
When sacral nerve roots are affected, individuals may experience radicular pain, similar to sciatica, radiating from the lower back into the buttocks and down the leg. Sensory disturbances are common, presenting as numbness, burning, or tingling in the perineum, buttocks, or legs. Motor weakness in the legs and feet can also develop, impacting balance and mobility. In more severe cases of nerve compression, particularly involving the lower sacral nerves, bladder, bowel, and sexual dysfunction may occur. Symptoms are typically localized to areas supplied by the compressed nerve roots, highlighting the direct relationship between cyst location and neuropathy.
Diagnosis and Treatment Approaches
Diagnosis of symptomatic Tarlov cysts as a cause of peripheral neuropathy involves a comprehensive evaluation. A healthcare provider typically begins with a detailed symptom review and a thorough neurological examination, focusing on sacral nerve functions. Magnetic Resonance Imaging (MRI) of the sacral spine is the primary diagnostic tool, clearly showing cyst size, location, and relationship to surrounding nerve roots and bone. Sometimes, additional tests like nerve root blocks or cyst fluid aspiration confirm the cyst as the pain source.
Treatment for symptomatic Tarlov cysts varies based on symptom severity and individual factors. Conservative management is often the first step, including pain medications, anti-inflammatory drugs, and physical therapy to alleviate symptoms. For persistent or severe symptoms, interventional procedures like CT-guided cyst fluid aspiration, sometimes followed by fibrin glue injection to prevent refilling, may be considered. If conservative and less invasive treatments do not provide sufficient relief, surgical options like microsurgical decompression of nerve roots may be pursued. Surgical intervention carries risks and is typically reserved for individuals with significant or progressive neurological deficits.