Hypertensive encephalopathy and hypertrophic olivary degeneration

Case contributed by Frank Gaillard
Diagnosis certain


Prior cerebellar hemisphere and intraventricular hemorrhage.

Patient Data

Age: 75 years

There is evidence of prior posterior fossa hemorrhage with residual hemosiderin staining along the left lateral wall of the fourth ventricle and subjacent cerebellar parenchyma. Note is made of changes in the right olivary nucleus consistent with hypertrophic olivary degeneration.

Multiple small susceptibility foci scattered predominantly through the basal ganglia, brainstem, and cerebellum are consistent with chronic hypertensive encephalopathy. High T2/FLAIR signal abnormalities scattered through the supratentorial white matter are consistent with chronic small vessel ischemia. Prominent basal ganglia perivascular spaces and a right side old lacunar infarct. 

Case Discussion

This patient has long-standing and well-documented difficult to control hypertension. The distribution of microhemorrhages is characteristic of hypertension, matching the distribution of larger hemorrhage. The prior left cerebellar hemisphere hemorrhage, involving the left dentate nucleus, is the cause of the right sided hypertrophic olivary degeneration (HOD). 

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