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Credit The cover photograph was taken by William Banner, MD. Dr. Banner gives his permission for use.
A 70-year-old man with an 8-month history of left posterior thigh and leg pain was admitted to our Emergency Department after a fall during a gym session. He presented with a moderate pelvic and head trauma. A physical examination showed only tenderness upon palpation and percussion of the lumbar and sacral spine. Plain radiographic examinations of spine, pelvis Inhibitors,research,lifescience,medical and chest were interpreted as normal. The patient had no medical or surgical history other than essential hypertension. A few hours after admission, he became very confused and agitated. A cerebral computed tomography scan did not show either vascular lesion or cerebral contusion but fat droplets in the lateral ventricles (Figure (Figure1A).1A). A further investigation with CT scan of the spine revealed a fractured sacrum extending into a ruptured perineurial cyst (Figure (Figure2A).2A). A cerebral and spinal magnetic resonance image (MRI) scan confirmed Inhibitors,research,lifescience,medical these findings (Figures (Figures1B,1B, 2B-C) and we suspected that fatty bone marrow had migrated from sacral fracture to the brain in an unusual Inhibitors,research,lifescience,medical way: a dural breach at the Tarlov cyst. Surgical treatment was not carried
out because of the fractured sacrum. The patient remained under medical observation and fully recovered within three weeks. Two months after Inhibitors,research,lifescience,medical discharge, the patient had no complaints and had a normal physical neurological examination. Figure 1 Head CT-scan and MRI image. A. Post contrast head CT-scan:
fat droplets in the frontal horns of the lateral ventricles (white arrows). B. Sagittal T1-weighted head MR image: fat droplets disseminated in the subarachnoid spaces (white arrows). Figure 2 Sacral cyst CT-scan and MRI image. A. Axial sacral CT-scan: left sacral fracture extending to the S2 radicular cyst (presence of a contralateral cyst at the same level). B. Sagittal T2-weighted sacral MR image: S2 Inhibitors,research,lifescience,medical radicular cyst with two liquids: cerebrospinal … Discussion Tarlov cysts were first www.selleckchem.com/products/gsk2606414.html described in 1938 as an incidental finding at autopsy of fillum terminale [2]. Then Tarlov described cases of symptomatic (low back pain) perineurial cyst and recommended their surgical removal with sacral laminectomy and excision of click here the cyst along the nerve root [3]. More recently, Paulsen et al [4] reported an incidence of Tarlov cysts which accounted for 1% of all back pains reported. They are more common in females [4]. The usual clinical presentations are pain in the lower back, sciatica, coccydynia or cauda equina syndrome. Usually, pain is intermittent and most frequently exacerbated by standing, walking and coughing. Tarlov’s perineurial cysts were initially described in the posterior sacral or coccygeal nerve roots [3].