Presentation
Hypertensive patient with history of cerebral hemorrhage 8 month ago presented with fascial and upper extremities tremors.
Patient Data
The right thalamic region and right internal capsule demonstrate area of cystic encephalomalacia surrounded by a hemosiderin rim of low signal in all pulse sequences which is seen extending downward into the midbrain involving the right cerebral peduncle, right red nucleus, and right tectum down to the right posterior part of pons (right medial lemniscus) suggesting old hematoma.
The right inferior olivary nucleus is swollen and demonstrates low signal in T1, increased T2, and FLAIR signal without restricted diffusion, suggesting a hypertrophic olivary nucleus.
Case Discussion
Hypertrophic olivary degeneration is a form of trans-neuronal degeneration that occurs secondary to interruption of the neurons in the Guillain–Mollaret triangle. It usually occurs secondary to injury in the midbrain or pons on the same side as the hypertrophied olivary nucleus, as in this case.
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