A Multilevel "Mickey Mouse" Appearance of Bilateral Lumbosacral Tarlov Cysts

Introduction: Tarlov cysts are perineural cysts between the perineurium and endoneurium, arising near the dorsal root ganglion. They can occur anywhere in the spine but most frequently around the sacral nerve roots.While typically asymptomatic, some cases can present with neurological symptoms.

Methods: We report the case of a 38-year-old woman, presented to our department with episodes of paroxysmal paresthesia in both lower limbs, unaccompanied by radicular pain or bladder/bowel disturbances. Physical examination showed normal motor and sensory function without focal neurological deficits. Medullary MRI revealed a distinctive "Mickey Mouse" multilevel appearance of bilateral lumbosacral Tarlov cysts. Given the absence of significant motor or sensory impairment, a conservative treatment approach was pursued.

Results: The patient was managed medically with analgesics and anti-inflammatory agents to alleviate symptoms, and she was referred for physical rehabilitation therapy to address and potentially improve her paresthetic symptoms. To date, no surgical intervention has been performed.The patient’s progress is currently under follow-up to monitor for symptom evolution or potential indications for surgical consideration.

Conclusion : This case illustrates a unique presentation of multilevel lumbosacral Tarlov cysts in a young female with atypical paroxysmal paresthesia as the primary complaint. Given the benign imaging findings and lack of severe neurological deficits, a conservative management plan was chosen.