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slug: "hypertrophic-olivary-degeneration"
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treeNodeId: null
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category: "Brain"
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cmeTopicId: "b70885e6-d7ea-4f0f-8b2c-c871245fd05c"
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documentVersionId: "0c307ba9-ac00-479c-9a0f-4201c66bc1f1"
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imageCount: 26
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lastUpdated: "09/30/20"
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@@ -333,7 +332,7 @@ breadcrumbs:
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- Avoid misdiagnosis of tumor or multiple sclerosis
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- Bilateral & symmetrical lesions in ION argue against subacute infarct & vertebral artery dissection
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9342df55-d4e7-4743-8a78-b03338f00dc0
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88b7142c-a73e-4046-a5d4-0c12bddb8133
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## References
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@@ -369,87 +368,195 @@ breadcrumbs:
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### Selected Images
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*Axial graphic of the upper medulla shows the medullary pyramids <img src='img/arrows/CC.png'/> on each side of the ventral median fissure. The olives <img src='img/arrows/CO.png'/> lie just posterior to the preolivary sulci <img src='img/arrows/CS.png'/>.*
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*Axial graphic of the upper medulla shows the medullary pyramids <img src='img/arrows/CC.png'/> on each side of the ventral median fissure. The olives <img src='img/arrows/CO.png'/> lie just posterior to the preolivary sulci <img src='img/arrows/CS.png'/>.*
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*Axial graphic of the upper medulla shows the medullary pyramids <img src='img/arrows/CC.png'/> on each side of the ventral median fissure. The olives <img src='img/arrows/CO.png'/> lie just posterior to the preolivary sulci <img src='img/arrows/CS.png'/>.*
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*Coronal graphic of the midbrain, pons, and medulla is sectioned to depict the Guillain-Mollaret triangle (GMT). The GMT is composed of the ipsilateral inferior olivary nucleus (green), dentate nucleus (blue) of the contralateral cerebellum, and the ipsilateral red nucleus (RN, red).*
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*Coronal graphic of the midbrain, pons, and medulla is sectioned to depict the Guillain-Mollaret triangle (GMT). The GMT is composed of the ipsilateral inferior olivary nucleus (green), dentate nucleus (blue) of the contralateral cerebellum, and the ipsilateral red nucleus (RN, red).*
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*Coronal graphic of the midbrain, pons, and medulla is sectioned to depict the Guillain-Mollaret triangle (GMT). The GMT is composed of the ipsilateral inferior olivary nucleus (green), dentate nucleus (blue) of the contralateral cerebellum, and the ipsilateral red nucleus (RN, red).*
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*Axial T2 MR of a 40-year-old woman with brainstem glioma and secondary hypertrophic olivary degeneration (HOD) shows a heterogeneous mass lesion involving midbrain <img src='img/arrows/CO.png'/> invading the RN <img src='img/arrows/CS.png'/> (R > L). RN is a component of GMT.*
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*Axial T2 MR of a 40-year-old woman with brainstem glioma and secondary hypertrophic olivary degeneration (HOD) shows a heterogeneous mass lesion involving midbrain <img src='img/arrows/CO.png'/> invading the RN <img src='img/arrows/CS.png'/> (R > L). RN is a component of GMT.*
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*Axial T2 MR of a 40-year-old woman with brainstem glioma and secondary hypertrophic olivary degeneration (HOD) shows a heterogeneous mass lesion involving midbrain <img src='img/arrows/CO.png'/> invading the RN <img src='img/arrows/CS.png'/> (R > L). RN is a component of GMT.*
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*Axial T2 MR at the level of medulla in the same patient shows enlarged right inferior olivary nucleus with hyperintense signal <img src='img/arrows/CC.png'/> indicating HOD. Also note normal-appearing left olivary nucleus <img src='img/arrows/BC.png'/> and preolivary sulcus <img src='img/arrows/BS.png'/>.*
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*Axial T2 MR at the level of medulla in the same patient shows enlarged right inferior olivary nucleus with hyperintense signal <img src='img/arrows/CC.png'/> indicating HOD. Also note normal-appearing left olivary nucleus <img src='img/arrows/BC.png'/> and preolivary sulcus <img src='img/arrows/BS.png'/>.*
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*Axial T2 MR at the level of medulla in the same patient shows enlarged right inferior olivary nucleus with hyperintense signal <img src='img/arrows/CC.png'/> indicating HOD. Also note normal-appearing left olivary nucleus <img src='img/arrows/BC.png'/> and preolivary sulcus <img src='img/arrows/BS.png'/>.*
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*Axial FLAIR MR of a 58-year-old woman presenting with palatal myoclonus and a history of treated CNS lymphoma shows volume loss and hyperintense signal in left dentate nucleus (DN) <img src='img/arrows/CO.png'/> due to encephalomalacia (DN is a component of GMT).*
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*Axial FLAIR MR of a 58-year-old woman presenting with palatal myoclonus and a history of treated CNS lymphoma shows volume loss and hyperintense signal in left dentate nucleus (DN) <img src='img/arrows/CO.png'/> due to encephalomalacia (DN is a component of GMT).*
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*Axial FLAIR MR of a 58-year-old woman presenting with palatal myoclonus and a history of treated CNS lymphoma shows volume loss and hyperintense signal in left dentate nucleus (DN) <img src='img/arrows/CO.png'/> due to encephalomalacia (DN is a component of GMT).*
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*Axial T2 MR in the same patient at the level of medulla shows mild hypertrophy and increased signal involving bilateral inferior olivary nuclei <img src='img/arrows/CC.png'/> indicating HOD.*
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*Axial T2 MR in the same patient at the level of medulla shows mild hypertrophy and increased signal involving bilateral inferior olivary nuclei <img src='img/arrows/CC.png'/> indicating HOD.*
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*Axial T2 MR in the same patient at the level of medulla shows mild hypertrophy and increased signal involving bilateral inferior olivary nuclei <img src='img/arrows/CC.png'/> indicating HOD.*
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*Axial T2 of a 67-year-old man with left para median pontine cavernous malformation (CM) involving central tegmental tract resulting in ipsilateral HOD shows hyperintense popcorn lesion with rim of hemosiderin in left para median pons <img src='img/arrows/CS.png'/> due to CM.*
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*Axial T2 of a 67-year-old man with left para median pontine cavernous malformation (CM) involving central tegmental tract resulting in ipsilateral HOD shows hyperintense popcorn lesion with rim of hemosiderin in left para median pons <img src='img/arrows/CS.png'/> due to CM.*
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*Axial T2 of a 67-year-old man with left para median pontine cavernous malformation (CM) involving central tegmental tract resulting in ipsilateral HOD shows hyperintense popcorn lesion with rim of hemosiderin in left para median pons <img src='img/arrows/CS.png'/> due to CM.*
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*Axial FLAIR MR in the same patient shows enlarged left inferior olivary nucleus with hyperintense signal <img src='img/arrows/CO.png'/> due to HOD.*
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*Axial FLAIR MR in the same patient shows enlarged left inferior olivary nucleus with hyperintense signal <img src='img/arrows/CO.png'/> due to HOD.*
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*Axial FLAIR MR in the same patient shows enlarged left inferior olivary nucleus with hyperintense signal <img src='img/arrows/CO.png'/> due to HOD.*
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*Axial T2 MR at 1 day (top left), 4 months (top right), and 7 months (bottom left) postoperative follow-up show edema in left DN <img src='img/arrows/CS.png'/> and normal right olive <img src='img/arrows/CO.png'/>. Note light enlargement and ↑ signal in right olive <img src='img/arrows/CC.png'/>, progressive enlargement and ↑ signal in olive <img src='img/arrows/WC.png'/>, and lack of enhancement in olive <img src='img/arrows/WO.png'/> on postcontrast T1WI (bottom right).*
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*Axial T2 MR at 1 day (top left), 4 months (top right), and 7 months (bottom left) postoperative follow-up show edema in left DN <img src='img/arrows/CS.png'/> and normal right olive <img src='img/arrows/CO.png'/>. Note light enlargement and ↑ signal in right olive <img src='img/arrows/CC.png'/>, progressive enlargement and ↑ signal in olive <img src='img/arrows/WC.png'/>, and lack of enhancement in olive <img src='img/arrows/WO.png'/> on postcontrast T1WI (bottom right).*
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*Axial T2 MR at 1 day (top left), 4 months (top right), and 7 months (bottom left) postoperative follow-up show edema in left DN <img src='img/arrows/CS.png'/> and normal right olive <img src='img/arrows/CO.png'/>. Note light enlargement and ↑ signal in right olive <img src='img/arrows/CC.png'/>, progressive enlargement and ↑ signal in olive <img src='img/arrows/WC.png'/>, and lack of enhancement in olive <img src='img/arrows/WO.png'/> on postcontrast T1WI (bottom right).*
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*Axial graphic of the midbrain at the level of the hypoglossal nuclei shows the distinct wavy pattern of the olives <img src='img/arrows/CS.png'/> corresponding to the FLAIR hyperintensity in the previous image.*
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*Axial graphic of the midbrain at the level of the hypoglossal nuclei shows the distinct wavy pattern of the olives <img src='img/arrows/CS.png'/> corresponding to the FLAIR hyperintensity in the previous image.*
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*Axial graphic of the midbrain at the level of the hypoglossal nuclei shows the distinct wavy pattern of the olives <img src='img/arrows/CS.png'/> corresponding to the FLAIR hyperintensity in the previous image.*
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### Additional Images
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*Axial T2WI MR demonstrates hypertrophy of both inferior olivary nuclei, which are also hyperintense <img src='img/arrows/CS.png'/>, secondary to HOD.*
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*Axial T2WI MR demonstrates hypertrophy of both inferior olivary nuclei, which are also hyperintense <img src='img/arrows/CS.png'/>, secondary to HOD.*
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*Axial T2WI MR demonstrates hypertrophy of both inferior olivary nuclei, which are also hyperintense <img src='img/arrows/CS.png'/>, secondary to HOD.*
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*Sagittal FLAIR MR shows abnormally ↑ signal intensity in an anterior medullary area <img src='img/arrows/CS.png'/> that corresponds to the inferior olivary nucleus.*
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*Sagittal FLAIR MR shows abnormally ↑ signal intensity in an anterior medullary area <img src='img/arrows/CS.png'/> that corresponds to the inferior olivary nucleus.*
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*Axial FLAIR MR in the same patient who suffered midbrain hemorrhage (not shown) depicts bilateral hyperintense and hypertrophied inferior olivary nuclei <img src='img/arrows/CS.png'/>.*
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*Axial FLAIR MR in the same patient who suffered midbrain hemorrhage (not shown) depicts bilateral hyperintense and hypertrophied inferior olivary nuclei <img src='img/arrows/CS.png'/>.*
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*Axial FLAIR MR shows high signal intensity and asymmetric enlargement of right anterior medulla corresponding to the region of hypertrophic degeneration of the right inferior olivary nucleus <img src='img/arrows/CS.png'/> .*
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*Axial FLAIR MR shows high signal intensity and asymmetric enlargement of right anterior medulla corresponding to the region of hypertrophic degeneration of the right inferior olivary nucleus <img src='img/arrows/CS.png'/> .*
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*Axial T2WI MR in the same patient shows a right pontine infarct, the primary lesion that led to right HOD.*
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*Axial T2WI MR in the same patient shows a right pontine infarct, the primary lesion that led to right HOD.*
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*Axial T2WI MR shows bilateral symmetric hypertrophy with ↑ signal intensity confined to inferior olivary nuclei, with loss of pre- and postolivary sulci <img src='img/arrows/CS.png'/>.*
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*Axial T2WI MR shows bilateral symmetric hypertrophy with ↑ signal intensity confined to inferior olivary nuclei, with loss of pre- and postolivary sulci <img src='img/arrows/CS.png'/>.*
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*Axial T2WI MR in the same patient shows the primary midbrain lesion that caused the occurrence of bilateral HOD.*
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*Axial T2WI MR in the same patient shows the primary midbrain lesion that caused the occurrence of bilateral HOD.*
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*Axial T2WI MR in a patient who developed onset of dysarthria and upper extremity dysmetria 15 months following stereotaxic XRT for midbrain arteriovenous malformation shows mixed hyper-/hypointensity in the residual vascular malformation <img src='img/arrows/CO.png'/>.*
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*Axial T2WI MR in a patient who developed onset of dysarthria and upper extremity dysmetria 15 months following stereotaxic XRT for midbrain arteriovenous malformation shows mixed hyper-/hypointensity in the residual vascular malformation <img src='img/arrows/CO.png'/>.*
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*Axial T2WI MR in the same patient shows bilateral inferior olivary hyperintensity and hypertrophy <img src='img/arrows/CS.png'/>.*
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*Axial T2WI MR in the same patient shows bilateral inferior olivary hyperintensity and hypertrophy <img src='img/arrows/CS.png'/>.*
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*Axial T2WI MR (CISS) shows the normal shape of the medullary olives <img src='img/arrows/CS.png'/>.*
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*Axial T2WI MR (CISS) shows the normal shape of the medullary olives <img src='img/arrows/CS.png'/>.*
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*Axial T2WI MR in a patient who developed palatal myoclonus ~ 6 months after resection of a midbrain CM shows hyperintensity and enlargement of both olives <img src='img/arrows/CS.png'/>. This pattern is typical in the subacute stage of HOD, which typically appears between 6 months and 3-4 years after injury to the dentato-rubro-olivary pathway.*
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*Axial T2WI MR in a patient who developed palatal myoclonus ~ 6 months after resection of a midbrain CM shows hyperintensity and enlargement of both olives <img src='img/arrows/CS.png'/>. This pattern is typical in the subacute stage of HOD, which typically appears between 6 months and 3-4 years after injury to the dentato-rubro-olivary pathway.*
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*Axial SWI MR demonstrates hemosiderin staining in the dorsal aspect of the brainstem <img src='img/arrows/CC.png'/> in the midline and to the right due to an old hemorrhage.*
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*Axial SWI MR demonstrates hemosiderin staining in the dorsal aspect of the brainstem <img src='img/arrows/CC.png'/> in the midline and to the right due to an old hemorrhage.*
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*Axial FLAIR MR in the same patient at the level of the medulla shows mild hypertrophy with hyperintensity in the region of the right inferior olivary nucleus <img src='img/arrows/CS.png'/>. Findings are typical for HOD caused by primary lesions in dentato-rubro-olivary pathway (anatomical GMT).*
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*Axial FLAIR MR in the same patient at the level of the medulla shows mild hypertrophy with hyperintensity in the region of the right inferior olivary nucleus <img src='img/arrows/CS.png'/>. Findings are typical for HOD caused by primary lesions in dentato-rubro-olivary pathway (anatomical GMT).*
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*Axial T2WI MR through the medulla shows that the ipsilateral olive is atrophic and hyperintense <img src='img/arrows/CS.png'/>. This patient also has crossed cerebellar atrophy <img src='img/arrows/CO.png'/> due to interruption of the ponto-cerebellar pathway.*
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*Axial T2WI MR through the medulla shows that the ipsilateral olive is atrophic and hyperintense <img src='img/arrows/CS.png'/>. This patient also has crossed cerebellar atrophy <img src='img/arrows/CO.png'/> due to interruption of the ponto-cerebellar pathway.*
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*Axial T2WI MR in a patient who developed palatal myoclonus several months following midbrain surgery for CM. Imaging obtained 1 year later shows residual CM <img src='img/arrows/CO.png'/>.*
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*Axial T2WI MR in a patient who developed palatal myoclonus several months following midbrain surgery for CM. Imaging obtained 1 year later shows residual CM <img src='img/arrows/CO.png'/>.*
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*Axial FLAIR MR in the same patient delineates the somewhat wavy appearance of the hyperintensity conforming to the configuration of the olives <img src='img/arrows/CS.png'/>. The pyramids <img src='img/arrows/CO.png'/> are spared, helping differentiate HOD from perforating artery infarction.*
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*Axial FLAIR MR in the same patient delineates the somewhat wavy appearance of the hyperintensity conforming to the configuration of the olives <img src='img/arrows/CS.png'/>. The pyramids <img src='img/arrows/CO.png'/> are spared, helping differentiate HOD from perforating artery infarction.*
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