A Tarlov cyst is a sac of fluid within the spine that can only be a complication of Ehlers Danlos syndrome (EDS) and resulted in a long-lasting loss of control over bowel and bladder (incontinence) within a young boy who was hypermobile EDS as a study revealed.
Although several cases that involve Tarlov cysts among adults suffering from EDS have been identified, this is believed to be the only reported case of a child patient.
The study suggests the idea of screening EDS patients for signs of incontinence as well as other neurological signs to determine spinal cord involvement. It also suggests treating a possible Tarlov tumor earlier according to the study.
It’s possible that early identification and treatment for the cyst might have stopped the progression of symptoms and lead to complete cure for the boy’s urinary incontinence. However, this did not take place, according to the research team.
The article, ” A Case of a Tarlov Cyst In the Pediatric Patient with Ehlers-Danlos Syndrome,” was published in Cureus.
Hypermobile EDS is the most frequent kind of EDS. Patients might be hypermobile, or unusually mobile joints that are prone to dislocation joints, joint pain, delicate skin that bruises or breaks easily as well as scoliosis (an abnormally curving spine).
Patients may also experience neurological issues, such as muscular skeletal pain, fatigue muscle weakness, involuntary contractions, as well as paresthesia (numbness or pain sensations).
A rare neurologic complication associated with EDS is the Tarlov cyst, which is a sac filled with fluid that covers the brain as well as spinal cord. It usually develops in the sacrum, an area of bone that lies at the base of spine.
The cyst can cause pressure on nerves, which can cause painful sacral areas, sciatica, and urinary and incontinence of the bowel. Sciatica is a kind of shock-like, burning pain which flows through down the back and up towards the back leg.
Tarlov cysts are rare in children EDS cases
“Tarlov cysts found in children’s population are a relatively rare occurrence,” the researchers wrote in their paper, noting that, within EDS patients, a few cases have been reported among adults, however just one case has been discovered in the child.
Researchers from Rowan University School of Osteopathic Medicine, Stratford, New Jersey have described the unique instance of the Tarlov cyst found in an 11-year-old boy suffering from hypermobile EDS who was diagnosed with urinary and constipation.
At the age of 9years old, the boy was taken to the hospital with bed-wetting and urinary incontinence, having experienced frequent bowel and urinary incontinence over the last two years. For this, medication to treat the signs of an active bladder were provided.
Imaging with magnetic resonance (MRI) identified the presence of a tethered spinal cord, meaning that it was in a different way attached to adjacent tissues surrounding the spine as well as it also revealed a Tarlov cyst in the sacrum.
At the age of 10 the boy had an operation to eliminate the cyst as well as parts of the two affected sacral vertebrae (the tiny bones that comprise part of the spine) to ease stress on spinal cord and eliminate tissues that attach to it.
The symptoms of urinary or constipation were quickly reduced and eased for approximately six months.
But, a year later, aged 11 years old, the boy’s urinary incontinence recurred at least five times a day and getting worse during daily activities. He also reported lower back sensations, numbness and pain as well as painful sensations.
The latest MRI scans revealed no Tarlov cysts, however a connected spinal cord was detected in the same area which was not seen on the earlier scan. The boy was treated to eliminate the remaining tissue attachments that caused the connected spinal cord.
After the surgery, he experienced improvement in mobility as well as reductions in lower back discomfort, unusual sensations and radiating leg pain.
The boy has continued to experience some bowel and urinary incontinence, as well as nerve pain they are being treated by a prescribed medications.
“This case demonstrates the importance in recognizing the Tarlov cyst in children who have the background of EDS,” the research team wrote. They added that it “raises the issue of whether earlier diagnosis and treatment might have stopped the progress in symptoms.”
“We suggest screening patients suffering from EDS for signs that include incontinence or lower extremity paraesthesia and pain in order to identify the root cause of spinal cord injury,” research authors wrote. “Identifying EDS early will allow you to intervene by surgery or medically to lessen the severity of symptoms.”
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