Title: Bilateral Hypertrophic Olivary Degeneration-A Rare and delayed complication following pontine hemmoraghe

Author: Praveen Kumar Yadav

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i8.70

Abstract

Hypertrophic Olivary Degeneration is rare transsynaptic degeneration secondary to lesions involving the anatomical triangle of Guillain and Mollaret or the dento-rubro-olivary pathway. Here we present a case of 37 year male with history of pontine bleed 6 months back with residual left spastic hemiparesis, able to walk without support after 2 months of initial stroke. Now presented with 6 weeks history of severe ataxia of gait and in coordination of limbs with action and intention tremors of extremities. MRI Brain showed presence of bilateral Hypertrophic olivary degeneration. Thus in patients with brainstem strokes with improvement initially followed bydelayed worsening with fresh cerebellar signs and tremors, a possibility of hypertrophic olivary degeneration should be considered. This may help us avoid unnecessary investigations and evaluation.

Keywords: Hypertrophic olivary degeneration Mollarets  Pontine Rubral tremor.

References

  1. Salamon-Murayama N, Russell EJ, and Rabin BM. Diagnosis pleases. Case 17: hypertrophic olivary degeneration secondary to pontine hemorrhage. Radiology 1999;213:814-7.      
  2. Deuschl, G. Mischke, E. Schenck, J. Schulte-M ¨ onting, and C. H. L¨ucking, “Symptomatic
  3. and essential rhythmic palatal myoclonus, ”Brain,vol.113,no.6,pp.1645–1672,1990.
  4. Goyal, E. Versnick, P. Tuite et al., “Hypertrophic olivary degeneration: meta-analysis of the temporal evolution of MR findings,”AmericanJournalofNeuroradiology,vol.21,no.6,pp. 1073–1077, 2000
  5. Matsuo F, Aiax Palatal myoclonus and denervation  supersensitivityin  the central nervous system. Ann  Ncurol 5:72-78.  197
  6. MatsuoF, Aiax Palatal myoclonus and denervation supersensitivityin the central nervous system. Ann Ncurol 5:72-78. 
  7. MatsuoF,Aiax Palatal myoclonus and denervation supersensitivity in the central nervous system. Ann Ncurol 5:72-78.  1979
  8. Matsuo FAjax ET. Palatal myoclonus and denervation supersensitivity in the central nervous system, Ann Neurol. 1979 Jan; 5 (1):72-8.
  9. Birbamer G, Gerstenbrand F, Aichner F, Buchberger W, Chemelli A, Langmayr J, et al. MR - imaging of post-traumatic olivary hypertrophy.Funct Neurol 1994;9:183-7   
  10. Kitajima M, Korogi Y, Shimomura O, Sakamoto Y, Hirai T, Miyayama H, et al. Hypertrophic olivary degeneration: MR imaging and pathologic findings. Radiology 1994;192:539-43
  11. Goto N, Kaneko M. Olivary enlargement: chronological and morphometric analyses. Acta Neuropathol (Berl) 1981;54:275–82
  12. Goto N, Kakimi S, Kaneko M. Olivary enlargement: stage of initial astrocytic changes. Clin Neuropathol 1988; 7: 39–43.
  13. Arora VNI, Sandhu PS, Singh J, Abrol R, Roop A. Hypertrophic olivary degener-ation following trauma – a case report. Ind J Radiol Imag 2006; 16(4):701–4.
  14. Vaidhyanath R, Thomas A, Messios N. Bilateral hypertrophic olivary degeneration following surgical resection of a posterior fossa epidermoid cyst. Br J Radiol 2010;83(994):e211–5
  15. Gerace C, Fele MR, Luna R, Piazza G. Neurological picture. Bilateral hypertr-ophic olivary degeneration. J Neurol Neurosurg Psychiatry 2006; 77(1):73.

Corresponding Author

Dr Praveen Kumar Yadav

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