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Abstract Details

Cyst Can't be the Case? A Unique Presentation of Multiple Tarlov Cysts
Neuromuscular and Clinical Neurophysiology (EMG)
P2 - Poster Session 2 (8:00 AM-9:00 AM)
1-001
To describe a unique presentation of multiple nerve root Tarlov cysts which can mimic radicular or neuropathic processes.

Tarlov cysts are cerebrospinal fluid filled cysts which originate between the posterior nerve root and dorsal root ganglion. They're often noted incidentally on imaging of the lumbosacral spine and are typically asymptomatic.

Case report
Our patient is a 60 year old female who presented with weakness and neuropathic pain in her left upper extremity. She described burning, hyperesthesia and numbness on the extensor surface of the left forearm and weakness with elbow flexion. She also described more recent development of similar sensory symptoms in the right arm without subjective weakness. Neurologic examination revealed patchy sensory loss to pinprick in C5-6 dermatomes. There was left C5-C6 myotome weakness with hyporeflexia at the biceps and brachioradialis. Electromyography (EMG) revealed evidence of active and chronic neurogenic changes in left C5-6/upper trunk innervated muscles. Evaluation of paraspinal muscles was normal. MRI of the cervical spine revealed T2 hyperintense cystic dilation of the proximal lower cervical and visualized upper thoracic nerve roots with minimal peripheral enhancement. Extension of MRI into the brachial plexus showed nonspecific mild enlargement and increased T2 signal of the brachial plexus, greatest proximally. Lumbar puncture revealed a bland CSF with normal cell count, protein and infectious studies. Genetic testing for PMP 22 was negative. Additional review of her MRI was undertaken and it was felt her imaging was consistent with multiple Tarlov/perineural cysts as opposed to an intrinsic neuropathic process. Additional MRI imaging of the thoracic and lumbar spine revealed further evidence of scattered Tarlov cysts. She had slow spontaneous improvement in left upper extremity strength and neuropathic symptoms.

Perineural/Tarlov cysts should be a potential differential diagnosis for enlarged nerve roots and plexus' when imaging reveals cystic thickening at the nerve root level.

Authors/Disclosures
Scott Speelziek, MD (Mayo Clinic)
PRESENTER 		Dr. Speelziek has nothing to disclose.
Derek W. Stitt, MD (Mayo Clinic) Dr. Stitt has nothing to disclose.