Multiple Sacral Perineurial Cysts Presented Symptoms Triggered by Nonaneurysmal Perimesencephalic Subarachnoid Hemorrhage

Abstract

The origin and pathogenesis of perineurial cysts remain unclear. Here, we report a rare case of multiple sacral perineurial cysts presented symptoms triggered by nonaneurysmal perimesencephalic subarachnoid hemorrhage (SAH). A 48-year-old male presented with a severe headache of sudden onset. Brain computed tomography revealed a SAH in the basal cistern; however, no abnormal vascular lesion was detected. Four days after the onset of the SAH, he suffered from left buttock pain, followed by urinary dysfunction and paresthesia in the left S2 and S3 dermatomes. Magnetic resonance (MR) imaging demonstrated multiple cystic lesions at the left S1 and bilateral S2 sacral roots. The two cysts at the S2 level exhibited high signal intensity on both T 1 - and T 2 -weighted images, suggesting the content of the cysts included a hematoma. He was treated with intravenous injections of steroids, and the symptoms recovered completely within 2 months. Follow-up MR imaging revealed remarkable shrinkage of the cysts. Sacral perineurial cysts should be listed in the differential diagnosis if the patient suffers from low back pain or sacral radiculopathy after the onset of SAH.

Transcatheter arterial embolization for a symptomatic Tarlov cyst with hemorrhage due to an underlying arteriovenous fistula

“…When the cyst fills with fluid, such as CSF or blood, the adjacent neural or body structure is compressed and pain develops. Pain after hemorrhage in the cysts is associated with SAH after rupture of a cerebral aneurysm [6] . In the present case, although SAH secondary to rupture of a cerebral aneurysm was not identified, the intra-cyst hematoma likely expanded the lesion, leading to clinical symptoms.…”

Giant Tarlov Cyst presenting as pelvic mass: Often doing less is better

“…Yamagami, [38] 2019 Nishimura et al, [23] Tokgöz et al, [34] Serratrice et al, [29] 2022 L5-S3 cyst with epidermoid in a 42-year-old woman was reported in year 2020. e case becomes more interesting when it is revealed that the epidermoid is Iatrogenic and acquired.…”

“…A review of the literature on Tarlov cysts showed that of the total 39 cases, the majority were females [Tables 1 and 2]. [30][31][32][33][35][36][37][38][39] ey are attributed to either musculoskeletal defects (supported by Tarlov cysts in collagen disorders like Marfan) that enlarge due to the hydrodynamic forces of CSF (i.e., continuous or pulsatile). In this series, patients averaged 40.35 years of age with a female threefold predominance.…”