Bilateral Hypertrophic Olivary Degeneration after Pontine Hemorrhage: A Case Report

Abstract

BACKGROUND Hemorrhage lesions may lead to bilateral hypertrophic olivary degeneration (HOD) through interruption of the dentato-rubral-olivary pathway. The pathological features of HOD are unusual neuronal trans-synaptic degenerative changes. CASE SUMMARY A 56-year-old female was admitted to our hospital because her lower extremities and left upper ones were unable to move for 3 mo, and the swelling of her right lower extremities became worse 3 days ago. She had a hypertension history. Her characteristic clinical manifestations are palatal myoclonus and nystagmus. The patient’s magnetic resonance imaging (MRI) results showed that she had bilateral HOD after an acute pontine hemorrhage. She was given symptomatic and supportive treatment. The gabapentin, the memantine and the trihexyphenidyl were taken twice a day each. The rehabilitation and psychotherapy were implemented. After 3 months of treatment, her eye symptoms improved. CONCLUSION Bilateral HOD is a rare phenomenon after pontine hemorrhage. The key to diagnosis lies in the clinical manifestations and MRI results.

Peduncular Hallucinosis 7 Months After Pontine Hemorrhage With Hypertrophic Olivary Degeneration: A Case Report

“…HOD is an enlargement of the inferior olivary nucleus and is rarely found following damage to the Guillain-Mollaret triangle (GMT) area [ 17 18 ]. It has been reported in some cases after pontine hemorrhage [ 19 20 ]. Pathologically, the most significant hypertrophy occurs 8.5 months after onset [ 21 ], and radiographically, it is observed on MR images 6 months after onset and disappears after 3 to 4 years [ 18 ].…”

Post-traumatic hypertrophic olivary degeneration associated with Holmes tremor: clinical-imaging correlation

“…En cuanto a los signos de neuroimagen característicos de DOH, hasta el momento no se han descrito consensos definitivos de Gold Standard diagnóstico 13,15 , por lo que la mayoría de los autores proponen la RMC como parte del arsenal para definir los criterios radiológicos, que usualmente se definen como un patrón de daño imagenológico unilateral e ipsilateral a la noxa causal ubicada predominantemente en el tronco encefálico en secuencias T2, específicamente en el recorrido del tracto tegmental central del TGM, con aumento de la hiperintensidad olivar inferior en T2 o FLAIR , producto de la Hipertrofia nuclear que suele revelarse 4 a 6 meses después de la instauración del agente etiológico 8,12,14,[16][17][18] .Varios de estos aspectos anteriormente mencionados en la literatura, se acoplan al caso en descripción, puesto que la resonancia magnética craneal del paciente mostró disrupción del TGM, dado por la asociación de una lesión hipointensa mesencefálica en T2 de tipo hemorrágica ipsilateralmente distanciada del núcleo olivar inferior hiperintenso afectado por DOH, en la misma secuencia imagenológica.…”

Vestibular Rehabilitation of Patient with Hypertrophic Olivary Degeneration: A Case Report

“…peaks at 8.5 months after injury. The third stage occurs 3 to 4 years after an injury, during which the ION recovers its regular volume or atrophies but maintains hyperintense signals on T2WI, which can last for several years 17 . In this case, initial CT scans indicated an acute bilateral pontine hemorrhage (Figure 1A) and 4.5 months later patient had developed new-onset tremors and ataxia.…”