Title : Tarlov cysts and the idiopathic cerebrospinal pressure dysregulation syndrome
Abstract:
Tarlov cysts remain a topic of controversy, from the first publication of Tarlov in 1938 and even now a myriad of treatments has been proposed for larger sacral cysts. For several reasons which will be discussed, Tarlov cysts have the tendency to be regarded as incidental findings. However, with a comprehensive history taking and perineal nerve conduction studies we might be able to distinguish better the symptomatic perineural cysts from the truly incidental finding (unpublished data). As these cysts are being considered as dilations of the nerve root sleeve the hydrostatic pressure together with pulsatile/dynamic features are coined to be the generators of the cysts and growth mechanism. An increase in intracranial pressure has been measured in our case series and with positive effects on the symptoms with CSF evacuation and Acetazolomide. Even small cysts seem to react positively on these diagnostic tests. As several studies show radiculopathy and axial pain as a general finding in idiopathic intracranial hypertension an idiopathic cerebrospinal pressure dysregulation syndrome might be proposed as a common denominator, for example in chronic fatigue syndrome and fibromyalgia. Audience Take Away: • How an incidental finding of sacral cysts evolved to an important cause of back pain and nerve root related symptoms • A potential missing link between fibromyalgia, chronic fatigue syndrome and idiopathic intracranial hypertension
