Low pressure headache and cerebral fat embolism from a sacral fracture through a Tarlov cyst: a case report

Abstract

Abstract Background Here we report the only formally documented case in the United Kingdom, to our knowledge, of a cerebral fat embolism secondary to non-iatrogenic trauma through a Tarlov cyst. This case demonstrates the pathology clearly giving an excellent opportunity to demonstrate a rarely seen pathology as well as illustrating the importance of the patient history to guiding further management. Case presentation A middle-aged patient was admitted on the acute medical take complaining of severe headache with photophobia, having just returned after a skiing holiday. Computerised tomography scan of the head showed fat within the anterior horn of both lateral ventricles, and within the subarachnoid space. Re-discussion with the patient and subsequent MRI (Magnetic Resonance Imaging) of the spine identified the pathogenesis of her symptoms: a sacral insufficiency fracture through a Tarlov cyst, causing subarachnoid fat embolism and symptoms of a low-pressure headaches due to a dural leak. Patient was medically managed and discharged with planned follow-up. Due to the Coronavirus pandemic and resolution of the patient's symptoms, they declined further follow up imaging. Conclusions The case demonstrates a rarely seen pathology as cause of a common presenting problem, headache. Emphasizing the importance of history taking and appropriate investigations in medical cases that do not conform to the usual diagnosis.

Keywords

• Tarlov Cyst—fluid filled nerve root cysts
• Embolism—a material causing a blockage inside of a blood vessel
• Neoplasm—Abnormal growth of tissue
• Meningitis—Infection of lining around the spine and brain
• Trigeminal autonomic cephalalgias—headache disorders that are caused by unilateral trigeminal distribution pain
• Photophobia—increased sensitivity to light