Hypertrophic olivary degeneration (bilateral) following midbrain hemorrhage

Case contributed by A.Prof Frank Gaillard


Sudden onset diplopia and weakness.

Patient Data

Age: 60 years
Gender: Female

There is a right tectal hematoma extending into the 4th ventricle. A small rim of edema surrounds the hematoma and there is compression of the right ambient and quadrigeminal plate cisterns. There is very mild dilatation of the lateral ventricle temporal horns. The remainder of the brain is unremarkable.

Bilateral paranasal sinus mucosal thickening and left sphenoid sinus mucus retention cyst noted.

The region of previous hemorrhage within the right side of the midbrain, extending inferiorly to the upper dorsal pons, just lateral and above the facial colliculus is again demonstrated, with no underlying lesion evident (no enhancing mass lesion, or abnormal vessels).

Since the hemorrhage, bilateral T2 hyper-intensity is seen involving the inferior olivary nuclei more so on the left and both are slightly swollen. 

Conclusion: Features are pathognomonic of hypertrophic olivary degeneration, due to interruption of the right central tegmental tract, and crossing dentatorubral tract, accounting the bilateral involvement. Clinical correlation with palatal myoclonus would be useful.

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Case information

rID: 35031
Published: 20th Mar 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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