Clinical Presentation

The Tarlov Cyst Society does not provide medical advice or clinical recommendations. This resource is intended to support awareness, education, and evidence-informed discussion among healthcare professionals caring for patients with known or suspected symptomatic Tarlov cysts.

Tarlov cysts, also known as perineural cysts, are cerebrospinal fluid-filled dilatations of the nerve root sheath, most commonly found in the sacral region. While some may remain asymptomatic, Tarlov cysts should not be automatically dismissed as incidental findings. When a cyst affects a nerve root, it may contribute to significant pain, neurological dysfunction, and reduced quality of life. Clinical significance should be evaluated individually, considering cyst location and characteristics, nerve root involvement, and the patient’s symptoms rather than cyst size alone.

Careful clinical correlation is especially important when symptoms correspond anatomically with the affected nerve root or cyst location. These may include positional or dermatomal pain, radicular symptoms, sensory or motor changes, and bladder, bowel, pelvic, or sexual dysfunction. The Tarlov Cyst Society encourages clinicians to consider Tarlov cysts as part of the differential diagnosis when symptoms and neurological findings are consistent with cyst location, rather than excluding them as a potential source or contributor simply because they were discovered incidentally on imaging.

Associated Conditions 

• Persistent sacral, gluteal, pelvic, perineal, radicular, or lower-back pain
• Pain worsened by sitting, standing, walking, or positional changes
• Numbness, tingling, weakness, or altered sensation in the affected nerve distribution
• Bladder, bowel, or sexual dysfunction, including urinary urgency, incomplete emptying, pain, or altered sensation
• Pelvic pressure or the sensation of “sitting on a lump”
• Fatigue or reduced function related to ongoing pain or nerve irritation

Red Flags

The following symptoms warrant urgent medical evaluation:

• Saddle anesthesia
• New loss of bladder or bowel control
• Progressive weakness
• Difficulty walking

Clinical considerations 

Women appear to be disproportionately affected by symptomatic Tarlov cysts, and presentations may mimic gynecological, urological, or pelvic floor disorders. Symptom correlation with imaging findings and affected nerve root distribution may help guide evaluation. 

Associated Conditions

Symptomatic Tarlov cysts may coexist with other neurological, connective tissue, or cerebrospinal fluid disorders that can complicate clinical presentation and symptom attribution.

Conditions reported in association with Tarlov cysts include:

• Connective tissue disorders (including hypermobile Ehlers-Danlos syndrome, Marfan syndrome, and Loeys-Dietz syndrome)
• Cerebrospinal fluid pressure disorders (including spontaneous CSF leaks and intracranial hypertension)
• Small- and large-fiber neuropathies
• Adhesive arachnoiditis
• Chiari malformation
• Tethered cord syndrome
• Pelvic neuropathic pain syndromes

Clinical evaluation should consider the broader neurological and connective tissue context, particularly when symptoms appear disproportionate to imaging findings alone.