An Uncommon Cause of Upper Limb Pain: Cervical Perineural (Tarlov) Cyst Chain

Palamar, Deniz; Mısırlıoğlu, Tuğçe Özekli; Akgün, Kenan

doi:10.1097/phm.0000000000000917

Cited by 4 publications

(1 citation statement)

References 3 publications

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“…The symptoms are usually aggravated when the patients tilt their heads in the opposite direction or when in a supine position [2,4,9]. More severe cases can be presented with muscle strength or sensory deficit in a specific myotomal or dermatomal pattern [9,10]. Our patient presented with both radicular symptoms and mild neurological manifestations including hypesthesia in C7-C8 dermatomal distribution and C7 myotomal distribution.…”

Section: Discussionmentioning

confidence: 75%

Successful Conservative Management of a Patient With Symptomatic Cervical Perineural Cysts: A Case Report

Stamiris,

Karampalis,

Stamiris

et al. 2024

Cureus

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Perineural cysts, also known as Tarlov cysts, are rare benign cerebrospinal fluid-filled cysts usually located at the junction of the posterior nerve root and the dorsal root ganglion and are usually asymptomatic. They are most commonly found in the sacral region and are uncommon in the cervical spine. Despite their rarity, symptomatic cases may present with neurological symptoms due to the compression of adjacent neurological structures. Symptomatic cervical perineural cysts are extremely rare, and there is limited consensus on management strategies. We present the case of a 56-year-old woman who presented with a four-week history of radicular symptoms involving the right C7 and C8 nerve roots, including neck and arm pain, paresthesias, and mild triceps weakness. Magnetic resonance imaging revealed two perineural cysts at the C6-C7 and C7-T1 levels. A conservative approach was chosen with a 14-day course of oral corticosteroids, use of a soft collar, and activity restrictions. Following this conservative treatment, a significant reduction in symptoms and complete neurological recovery were achieved. This case highlights the efficacy of conservative approaches in selected cases of mildly symptomatic cervical perineural cysts and contributes to a better understanding of management strategies for this condition.

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Section: Discussionmentioning

confidence: 75%

Successful Conservative Management of a Patient With Symptomatic Cervical Perineural Cysts: A Case Report

Stamiris,

Karampalis,

Stamiris

et al. 2024

Cureus

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Surgical Intervention is Associated with Improved Outcomes in Patients with Symptomatic Cervical Spine Tarlov Cysts: Results from a Prospective Cohort Study

Feigenbaum,

Parks,

Martin

et al. 2024

World Neurosurgery

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Treatment of a symptomatic cervical perineural cyst with ultrasound-guided cervical selective nerve root block

Lee

Kim

2018

Medicine

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Rationale:Symptomatic cervical perineural cysts are extremely rare, and they cause radicular pain by compressing the cervical nerve root. Several methods have been applied to manage the radicular pain induced by cervical perineural cysts, including medication, percutaneous procedures, and surgery. However, these methods are associated with various outcomes and complications. The percutaneous procedure is simple and easy to perform, but if the perineural cyst wall is punctured, it can lead to secondary complications, which include aseptic meningitis and intracranial hypotension.Patient concerns:A 51-year-old woman presented with a dull pain in the left shoulder and a tingling sensation in the left dorsal arm, hand, and middle finger.Diagnosis:The patient was diagnosed with left C7 radicular pain caused by a perineural cyst.Interventions:The left C7 radicular pain did not respond to treatment with medication. Therefore, a left C7 nerve root block with local anesthetics and steroids was performed under ultrasound guidance. Adjunctively, real-time fluoroscopy with contrast was used to avoid intravascular injection.Outcome:The symptoms resolved without any complications.Lessons:In this case, perineural cyst-induced radicular pain, which was resistant to medication, was treated using ultrasound guided cervical selective nerve root block with local anesthetics and steroids. Ultrasound guidance can enable successful cervical selective nerve root block without perineural cystic wall puncture. Therefore, ultrasound-guided cervical nerve root block is an effective treatment option for radicular pain caused by a symptomatic perineural cyst.

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An Uncommon Cause of Upper Limb Pain: Cervical Perineural (Tarlov) Cyst Chain

Cited by 4 publications

References 3 publications

Successful Conservative Management of a Patient With Symptomatic Cervical Perineural Cysts: A Case Report

Successful Conservative Management of a Patient With Symptomatic Cervical Perineural Cysts: A Case Report

Surgical Intervention is Associated with Improved Outcomes in Patients with Symptomatic Cervical Spine Tarlov Cysts: Results from a Prospective Cohort Study

Treatment of a symptomatic cervical perineural cyst with ultrasound-guided cervical selective nerve root block

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