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Hypertrophic Olivary Degeneration Due to Pontine Hemorrhage

Franklin A. Marden, MD1
[+] Author Affiliations
1Alexian Brothers Medical Center, Interventional Neuroradiology, Elk Grove Village, Illinois
JAMA Neurol. 2013;70(10):1330. doi:10.1001/2013.jamaneurol.359.
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A 71-year-old man presented with slowly progressive gait difficulty over several months due to left-sided ataxia, particularly affecting his leg. Fourteen months earlier, he had had a pontine hemorrhage (Figure 1A), causing left arm paralysis, from which he recovered. Magnetic resonance imaging (Figure 1B-D) showed findings consistent with hypertrophic olivary degeneration, ipsilateral to the prior bleed that had involved the central tegmental tract.

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Figure 1.
Brain Images

Computed tomography of the brain shows findings consistent with an acute hemorrhage in the tegmentum of the pons (A, arrow). Fourteen months later, magnetic resonance imaging shows residual blood products within this region (B, axial gradient-echo sequence). Separately, there is ipsilateral enlargement of the medulla and a round focus of hyperintense T2-weighted signal in the region of the inferior olivary nucleus (C, axial T2-weighted image and D, coronal T2-weighted image; arrows). The medullary lesion exhibited no enhancement or restricted diffusion on other sequences.

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Figure 2.
Diagram of the Dentato-rubral-olivary Pathway (Guillain-Mollaret Triangle)

Disruption of the afferent pathways to the inferior olive may cause hypertrophic olivary degeneration. CTT indicates central tegmental tract; DN, dentate nucleus; DRT, dentato-rubral tract; ICP, inferior cerebellar peduncle; ION, inferior olivary nucleus; OCT, olivo-cerebellar tract; RN, red nucleus; SCP, superior cerebellar peduncle.

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