Hypertrophic olivary degeneration

Case contributed by Dr Yune Kwong

Patient Data

Age: 65-70 years
Gender: Female

Initial scan performed for assessment of giant supra-sellar aneurysm. Patient had VP shunt (into corpus callosum!) for persistent hydrocephalus following hemorrhage.  


8 months later

On the follow-up scan, it is apparent that she has suffered hemorrhage into the pontine tegmentum. High signal and focal swelling is seen in the medulla (left > right).

Case Discussion

Hypertrophic olivary degeneration is secondary to trans-synaptic injury along the dentato-rubral-olivary pathway (better known as the triangle of Guillain-Mollaret). It is an unusual type of degeneration because it is associated with enlargement, rather than atrophy, of the inferior olivary neurons. Pathologically, it corresponds to vacuolar degeneration of cytoplasm that results in enlargement.

It is important to recognize this pattern of injury so that the changes in the medulla are not ascribed to a more serious cause, e.g. tumor, demyelination or infarct. The most important clue to the correct diagnosis is the association of a remote lesion along the pathway.

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Case information

rID: 23110
Published: 22nd May 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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