Disclosures: Fareea Khaliq, MD: No financial relationships or conflicts of interest

Case Diagnosis: Symptomatic case of Tarlov cyst disease in pregnancy.

Case Description or Program Description: A 24-year-old female who developed numbness in bilateral feet in her third trimester of pregnancy. Soon after delivery, she developed ascending paralysis along with bladder and bowel incontinence. These symptoms eventually progressed to the point where she became a wheelchair user.

Setting: Outpatient Clinic

Assessment/Results: Fourteen years after symptom onset, the patient was diagnosed with Tarlov cyst disease from an MRI of the lumbar spine. She underwent surgical removal resulting in improved motor and sensory levels and bladder and bowel function. She is now ambulating with a walker and only using a wheelchair for long distances.

Discussion (relevance): Tarlov cysts, which are saccular deformities of the nerve root sheath in the epidural spinal canal, are frequently asymptomatic and an incidental finding on CT and MR imaging. However, patients have developed severe radiculopathy and less commonly bladder dysfunction, bowel dysfunction, and sexual complications.

Conclusions: To our knowledge, this is the first case report of Tarlov cyst symptoms presenting during pregnancy. Though physicians and patients are hesitant to do any diagnostic imaging during pregnancy, one should look at the risks and benefits of the imaging. MRI does not use ionizing radiation and has not shown to be deleterious to the developing fetus and should be considered when a pregnant patient develops neuropathic symptoms and examination findings that are consistent with nerve root impingement. Clinicians need to perform a timely and thorough investigation with patients who present with the classical signs of an upper motor neuron spinal cord disease and Tarlov cyst disease should be on the differential for these patients to improve long-term independence and function.

Level of Evidence: Level I

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/tarlov-cyst-disease-in-pregnancy-a-case-report/