Introduction: Tarlov cysts are dilation of the nerve root sheaths and are abnormal sacs filled with cerebrospinal fluid that can cause a progressively painful radiculopathy which located most prevalently at S2-3 level of the sacrum. Childbirth and epidural anaesthesia are possible condition that might potentially cause the asymptomatic cysts to become symptomatic.

Case Summary: We presented a case of sacral Tarlov cyst diagnosed during post-partum period. Mdm. SNM is a 31-year-old psesudoprimigravida, whom was admitted in March 2017 at 36 weeks period of gestation (POG) for induction of labour in view of history of preterm prelabour rupture of membrane at 32 weeks POG. She was also class II maternal obesity with gestational diabetes mellitus on diet control antenatally. She had only one 3 mg dinoprostrone tablet inserted vaginally and artificial rupture of membrane was performed about 6 hours later in view of favourable cervix. During this time, she had epidural anaesthesia inserted at L4/5 level with continuous infusion of ropivacaine. However, she failed to progress further despite achieve optimal uterine contraction with intravenous oxytocin augmentation. She then underwent an emergency caesarean section for failed induction after 10 hours in labour. The surgery was uncomplicated with estimated blood loss of 400 cc. She was discharged well on day 2 post-operatively. However, patient presented to us 4 weeks postpartumly with lateral thigh and intermittent tingling sensation which persisted since post-delivery. She also complained of lower backache and intermittent numbness and tingling sensation over the lower abdomen region. Otherwise, she was able to ambulate and encountered no issue in micturition or bowel motion. Further neurological examination revealed no other nuerological deficit. Muscle power of both lower limb were full but reduced sensation over lateral thigh. Transabdominal Ultrasonography excluded the presence of pelvic abscess, pelvic masses or haematomato at pelvic region. MRI lumbar spine revealed a well-defined high signal intensity oval lesion at S2 region measuring 1.4×2.2×3.1 cm in keeping with Tarlov’s cyst and no evidence of nerve root impingement or spinal stenosis. She was currently planned for conservative management by neurosurgical team.

Discussion: Lateral thigh numbness is a common presentation in meralgia paresthetica in which it was the initial differential diagnosis for this patient. However, the symptoms usually ease and improved over the time in most patients. Tarlov cyst on the other hand is a rare disease and its optimal management were still remain controversy. MRI spine plays an important role for diagnosis and further management in future patient with similar presentation.