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Hydrocephalus associated with multiple Tarlov cysts.

Mieke Hulens1, Wim Dankaerts1, Ricky Rasschaert2

  • 1Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.

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Summary

Tarlov cysts (TCs) may be linked to increased intracranial pressure, a condition often seen in hydrocephalus. This pressure can cause distant symptoms like headaches and neuropathic pain, suggesting TCs should be screened for in hydrocephalus patients.

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Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Tarlov cysts (TCs) are cerebrospinal fluid (CSF)-filled dilations of nerve root sheaths, commonly in the sacrum.
  • Symptomatic TCs, causing chronic pain and functional deficits, are often overlooked.
  • TCs are hypothesized to arise from increased hydrostatic pressure (HP) within the dural sac.

Observation:

  • A case report details a 30-year-old male with a history of premature birth, intraventricular bleeding, and progressive hydrocephalus.
  • The patient presented with widespread pain (back, legs, thoracic, neck, arms), headaches, and bladder/bowel dysfunction.
  • Brain MRI revealed significant ventricular dilation without CSF flow obstruction, while spinal MRI showed multiple large TCs.

Findings:

  • The case suggests a correlation between hydrocephalus with a patent aqueduct and the presence of TCs.
  • Increased intracranial pressure in hydrocephalus may transmit to the spinal canal, elevating spinal HP.
  • This elevated spinal pressure could lead to the formation and dilation of spinal nerve root sheaths, forming TCs.

Implications:

  • Increased pressure within TCs may compress spinal neurons and axons, causing neuropathic pain and neurogenic bladder/bowel symptoms.
  • Hydrocephalus patients experiencing neuropathic pain warrant screening for Tarlov cysts.
  • This association highlights a potential mechanism linking intracranial and spinal pathologies and their associated symptoms.