{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T01:00:54Z","timestamp":1784682054103,"version":"3.55.0"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,7,20]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Spinal hemorrhagic disorders are relatively uncommon. Hematomas occurring outside the spinal canal, particularly around the spinal nerve root, are especially rare. To date, reported cases have been limited to a single case associated with a nerve root block procedure and 9 cases of Tarlov cyst hemorrhage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 35-year-old woman presented with acute right L5 radiculopathy and extensor hallucis longus weakness. MRI demonstrated a septated cystic lesion in the right L5\u2013S1 extraforaminal region adjacent to the L5 nerve root. Fluoroscopy-guided aspiration yielded a dark red liquefied hematoma with immediate symptom relief and radiographic reduction. The patient experienced recurrence 10 days later with worsened weakness; repeat aspiration of xanthochromic fluid resulted in rapid recovery. No recurrence was observed during 3 years of follow-up. This appears to be the first reported case of spontaneous perineural hematoma involving a spinal nerve root.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Acute unilateral lower limb radicular pain is commonly attributed to lumbar disc herniation. However, MRI may reveal an atypical lesion adjacent to the nerve root. Perineural hematoma should be included in the differential diagnosis of acute radiculopathy. Fluoroscopy-guided needle aspiration may offer a minimally invasive treatment option. Early MRI evaluation is important for accurate diagnosis and timely management.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26413\">https:\/\/thejns.org\/doi\/10.3171\/CASE26413<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26413","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:01:07Z","timestamp":1784678467000},"source":"Crossref","is-referenced-by-count":0,"title":["Spontaneous perineural hematoma of a lumbar nerve root presenting as radiculopathy successfully treated with needle aspiration: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7874-5294","authenticated-orcid":true,"given":"Junichi","family":"Yokosuka","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo"},{"name":"Department of Orthopaedic Surgery, Iwai Orthopaedic Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichi","family":"Takano","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo"},{"name":"Department of Orthopaedic Surgery, Iwai Orthopaedic Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8584-5672","authenticated-orcid":true,"given":"Hirohiko","family":"Inanami","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5722-8706","authenticated-orcid":true,"given":"Hiroki","family":"Iwai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Iwai Orthopaedic Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Pain Pract","first-page":"271","article-title":"Perineural hematoma following lumbar transforaminal steroid injection causing acute-on-chronic lumbar radiculopathy: a case report","volume":"14","author":"Desai","year":"2014","unstructured":"Desai MJDua S.Perineural hematoma following lumbar transforaminal steroid injection causing acute-on-chronic lumbar radiculopathy: a case report. Pain Pract. 2014;14(3):271-277. doi:10.1111\/papr.12047"},{"issue":"2","key":"bib2","series-title":"J Korean Neurosurg Soc","first-page":"123","article-title":"Symptomatic Tarlov cyst following spontaneous subarachnoid hemorrhage","volume":"50","author":"Kong","year":"2011","unstructured":"Kong WKCho KTHong SK.Symptomatic Tarlov cyst following spontaneous subarachnoid hemorrhage. J Korean Neurosurg Soc. 2011;50(2):123-125. doi:10.3340\/jkns.2011.50.2.123"},{"key":"bib3","series-title":"BMJ Case Rep","first-page":"bcr2017219890","article-title":"Incomplete cauda equina syndrome secondary to haemorrhage within a Tarlov cyst","volume":"2017","author":"Yates","year":"2017","unstructured":"Yates JRJones CSStokes OMHutton M.Incomplete cauda equina syndrome secondary to haemorrhage within a Tarlov cyst. BMJ Case Rep. 2017;2017:bcr2017219890. doi:10.1136\/bcr-2017-219890"},{"issue":"1","key":"bib4","series-title":"Clin Neuroradiol","first-page":"123","article-title":"Tarlov cyst hemorrhage causing acute radiculopathy: a case report","volume":"28","author":"Godel","year":"2018","unstructured":"Godel TPham MWolff MBendszus MB\u00e4umer P.Tarlov cyst hemorrhage causing acute radiculopathy: a case report. Clin Neuroradiol. 2018;28(1):123-125. doi:10.1007\/s00062-017-0597-5"},{"issue":"8","key":"bib5","series-title":"Medicine (Baltimore)","first-page":"e14184","article-title":"Perineural cyst with intracystic hemorrhage following aneurysmal subarachnoid hemorrhage: a case report","volume":"98","author":"Cho","year":"2019","unstructured":"Cho KTNam K.Perineural cyst with intracystic hemorrhage following aneurysmal subarachnoid hemorrhage: a case report. Medicine (Baltimore). 2019;98(8):e14184. doi:10.1097\/MD.0000000000014184"},{"issue":"2","key":"bib6","series-title":"NMC Case Rep J","first-page":"57","article-title":"Multiple sacral perineurial cysts presented symptoms triggered by nonaneurysmal perimesencephalic subarachnoid hemorrhage","volume":"6","author":"Yamagami","year":"2019","unstructured":"Yamagami KShono TIihara K.Multiple sacral perineurial cysts presented symptoms triggered by nonaneurysmal perimesencephalic subarachnoid hemorrhage. NMC Case Rep J. 2019;6(2):57-60. doi:10.2176\/nmccrj.cr.2018-0242"},{"issue":"8","key":"bib7","series-title":"Oxf Med Case Reports","first-page":"omab063","article-title":"Haemorrhagic Tarlov cyst: a rare complication of anticoagulation therapy","volume":"2021","author":"Soon","year":"2021","unstructured":"Soon WCSun RCzyz M.Haemorrhagic Tarlov cyst: a rare complication of anticoagulation therapy. Oxf Med Case Reports. 2021;2021(8):omab063. doi:10.1093\/omcr\/omab063"},{"issue":"6","key":"bib8","series-title":"Radiol Case Rep","first-page":"1284","article-title":"Transcatheter arterial embolization for a symptomatic Tarlov cyst with hemorrhage due to an underlying arteriovenous fistula","volume":"16","author":"Yoshikawa","year":"2021","unstructured":"Yoshikawa TKatsumori THisano MYasumura TSasakura Y.Transcatheter arterial embolization for a symptomatic Tarlov cyst with hemorrhage due to an underlying arteriovenous fistula. Radiol Case Rep. 2021;16(6):1284-1287. doi:10.1016\/j.radcr.2021.02.056"},{"issue":"2","key":"bib9","series-title":"Joint Bone Spine","first-page":"105307","article-title":"Hemorrhagic Tarlov cyst","volume":"89","author":"Genicon","year":"2022","unstructured":"Genicon CLe Moigne F.Hemorrhagic Tarlov cyst. Joint Bone Spine. 2022;89(2):105307. doi:10.1016\/j.jbspin.2021.105307"},{"key":"bib10","series-title":"Front Surg","first-page":"788786","article-title":"CT-guided aspiration of a hemorrhagic Tarlov cyst for the treatment of a post-partum sciatica: a case report and a review of the literature","volume":"9","author":"Serratrice","year":"2022","unstructured":"Serratrice NTaifour SAttieh CCT-guided aspiration of a hemorrhagic Tarlov cyst for the treatment of a post-partum sciatica: a case report and a review of the literature. Front Surg. 2022;9:788786. doi:10.3389\/fsurg.2022.788786"},{"issue":"3","key":"bib11","series-title":"J Neurosurg","first-page":"366","article-title":"Updated assessment and current classification of spinal meningeal cysts","volume":"68","author":"Nabors","year":"1988","unstructured":"Nabors MWPait TGByrd EBUpdated assessment and current classification of spinal meningeal cysts. 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Elsevier; 2021:119-143. doi:10.1016\/B978-0-323-77602-8.00017-9"},{"issue":"6","key":"bib14","series-title":"World Neurosurg","first-page":"1977","article-title":"Intraneural hematoma: a proposed anatomic classification with potential treatment implications","volume":"84","author":"de Ruiter","year":"2015","unstructured":"de Ruiter GCWPrasad NKSpinner RJManiker AH.Intraneural hematoma: a proposed anatomic classification with potential treatment implications. World Neurosurg. 2015;84(6):1977-1984. doi:10.1016\/j.wneu.2015.08.063"},{"issue":"1","key":"bib15","series-title":"J Neuroinflammation","article-title":"Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy","volume":"14","author":"Edlmann","year":"2017","unstructured":"Edlmann EGiorgi-Coll SWhitfield PCCarpenter KLHHutchinson PJ.Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. 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