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Fiani B, Runnels J, Sarhadi K, Sarno E, Kondilis A. Oncologic causes of oculopalatal tremors: neurophysiology and treatment. Acta Neurol Belg 2021; 121:1111-1116. [PMID: 34286476 DOI: 10.1007/s13760-021-01761-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022]
Abstract
Oculopalatal tremor (OPT) is an acquired pathology characterized by continuous and rhythmical soft palatal movements combined with pendular nystagmus. Aside from vascular lesions, oncological masses affecting the dentatorubro-olivary pathway can impair brainstem and/or cerebellar pathways, manifesting as dyssynchronous movement. In this review, we delve into the neurophysiology of OPT along with oncological causes and treatment options based on the most recent clinical trial data. This literature review includes medication treatment data from clinical trials enrolling individuals with features of OPT, including acquired pendular nystagmus (APN). Trials were deemed eligible for inclusion in this review if one or more participants had symptoms determined by the trial authors to be caused by OPT. Trials investigating the treatment of APN secondary to a separate cause, such as multiple sclerosis, were excluded from this review. Several early treatments failed to demonstrate a benefit for patients with APN due to OPT. Trials of anticholinergic agents were largely ineffective and poorly tolerated. Botulinum toxin A demonstrated improvement in APN symptoms. Most recently, trials including memantine and gabapentin have demonstrated success with attenuation of APN. Surgical modalities such as DBS have yet to show improvement, though with only a single case report as evidence. Oculopalatal tremor is a unique manifestation of posterior fossa tumors disrupting the Guillain-Mollaret triangle. Symptom control through medication management has had limited success attributed to poor response and medication intolerance. Surgical modalities like DBS may have an emerging role in OPT treatment by targeting dyssynchronous activity in the dentatorubro-olivary pathway.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, 1150 N. Indian Canyon Dr., Palm Springs, CA, 92262, USA.
| | - Juliana Runnels
- Department of Radiation Oncology, Mount Sinai Hospital, New York, NY, USA
| | - Kasra Sarhadi
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Erika Sarno
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Athanasios Kondilis
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
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Hypertrophic olivary degeneration: A comprehensive review focusing on etiology. Brain Res 2019; 1718:53-63. [DOI: 10.1016/j.brainres.2019.04.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/08/2019] [Accepted: 04/22/2019] [Indexed: 12/27/2022]
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Onen MR, Moore K, Cikla U, Ucer M, Schmidt B, Field AS, Baskaya MK. Hypertrophic Olivary Degeneration: Neurosurgical Perspective and Literature Review. World Neurosurg 2018; 112:e763-e771. [PMID: 29382617 DOI: 10.1016/j.wneu.2018.01.150] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hypertrophic olivary degeneration (HOD) occurs because of posterior fossa or brainstem lesions that disrupt the dentato-rubro-olivary tract, well known as the Guillain-Mollaret triangle. Clinical and radiologic hallmarks of this condition are palatal myoclonus and T2 hyperintensity of the inferior olivary complex on magnetic resonance imaging (MRI), respectively. Because symptomatic HOD can complicate the recovery of patients with posterior fossa or brainstem lesions, the purpose of this study is to evaluate clinical and imaging findings of patients with HOD. METHODS Sixteen patients (8 female and 8 male) with a mean age of 40.7 years, (range, 5-83 years) years were included in this study based on clinical symptoms and MRI findings. RESULTS We reviewed the clinical and imaging findings in 16 cases of HOD at our institution. Seven patients (43.7%) had posterior fossa tumors, 6 patients (37.5%) had cavernoma, 2 patients (12.5%) sustained traumatic brain injury, and only 1 patient (6.2%) had cerebellar infarction. Posterior fossa surgery was performed in 13 (81.2%) of these patients. HOD was detected a mean of 7.2 months (range, 0.5-18 months) after surgery or primary neurologic insult. Unilateral HOD was observed in 10 patients (62.5%), while bilateral HOD was observed in only 6 patients (37.5%). Seven patients (43.7%) were asymptomatic for HOD, whereas 5 patients (31.2%) had symptoms attributable to HOD. Two patients died because of primary tumors, although mean follow-up after detection of HOD on MRI was 52.2 months (range, 1-120 months) in the remaining 14 patients. In these cases, no change in clinical symptoms or imaging findings was detected during follow-up. CONCLUSIONS In this series, posterior fossa tumors and cavernomas were the most common causes of HOD. Although most of the patients with HOD remained asymptomatic, HOD complicated the course of recovery in almost one quarter of the patients included in this study. Neurosurgeons should be aware of HOD, which has characteristic clinical and imaging findings. In addition, HOD can complicate the recovery of patients with disruption to the dentato-rubro-olivary tract.
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Affiliation(s)
- Mehmet Resid Onen
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Kelli Moore
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Ulas Cikla
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Melih Ucer
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Bradley Schmidt
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Aaron S Field
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Mustafa K Baskaya
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.
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Smets G, Lambert J, Tijssen M, Mai C, Decramer T, Vandenberghe W, Van Loon J, Demaerel P. The dentato-rubro-olivary pathway revisited: New MR imaging observations regarding hypertrophic olivary degeneration. Clin Anat 2017; 30:543-549. [PMID: 28247932 DOI: 10.1002/ca.22866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/17/2017] [Accepted: 02/23/2017] [Indexed: 11/07/2022]
Abstract
Hypertrophic olivary degeneration (HOD) following a lesion of the dentato-rubro-olivary pathway (DROP) is a well-known imaging finding and has extensively been described in the recent literature. We reviewed our patients with HOD as a result of a lesion of the DROP in order to analyze the disruption of the DROP and the resulting HOD in comparison with the literature. We observed unusual imaging findings in four patients. In two patients it concerned new observations related to the timing and imaging appearances of HOD. HOD became only visible 6 years after a lesion in the red nucleus in one patient and a cystic degeneration of the olivary nucleus was seen 3 years after the HOD in a second patient. In two patients we found HOD that could only be explained by the existence of an afferent feedback loop between the dentate nucleus and the inferior olivary nucleus and by the knowledge that these fibers run through the ipsilateral olivary nucleus before ending in the contralateral olivary nucleus. In one of these patients the lesion was located in the inferior cerebellar peduncle. In the other patient the lesion was located on the midline in the medulla oblongata. The imaging findings in these patients reveal new observations in the stages of imaging appearances in HOD and shed light on the forgotten dentato-olivary afferent feedback loop of the DROP. Clin. Anat. 30:543-549, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Gitte Smets
- Department of Radiology, University Hospital KU Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Julie Lambert
- Department of Radiology, University Hospital KU Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Maud Tijssen
- Department of Radiology, Maastricht University Medical Centre, P.O. Box 5800, Maastricht, 6202 AZ, The Netherlands
| | - Cindy Mai
- Department of Radiology, University Hospital KU Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Thomas Decramer
- Department of Neurosurgery, University Hospital KU Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Wim Vandenberghe
- Department of Neurology, University Hospital KU Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Johannes Van Loon
- Department of Neurosurgery, University Hospital KU Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Philippe Demaerel
- Department of Radiology, University Hospital KU Leuven, Herestraat 49, Leuven, B-3000, Belgium
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Hirano M, Hatzoglou V, Karimi S, Young RJ. Hypertrophic olivary degeneration resulting from posterior fossa masses and their treatments. Clin Imaging 2015; 39:787-90. [PMID: 26104225 DOI: 10.1016/j.clinimag.2015.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/12/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Characterize hypertrophic olivary degeneration (HOD) that develops from posterior fossa masses and their treatments. METHODS Retrospectively reviewed MR images and clinical data of 10 patients with posterior fossa masses and HOD. RESULTS Eight patients had cerebellar lesions, and two patients had pontine lesions. Lesions consisted of tumors, demyelination, and nonspecific necrosis. MRI showed T2 hyperintense signal in the inferior olive a median 86 days after the diagnosis of a posterior fossa lesion. HOD presented prior to surgery (n=2), after surgery (n=3), after surgery/radiation therapy (n=4), or without treatment (n=1). CONCLUSIONS HOD may develop from posterior fossa masses and surgical and/or radiation therapy.
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Affiliation(s)
- Miki Hirano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Vaios Hatzoglou
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Sasan Karimi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Robert J Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York.
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Koch J, Freisinger P, Feichtinger RG, Zimmermann FA, Rauscher C, Wagentristl HP, Konstantopoulou V, Seidl R, Haack TB, Prokisch H, Ahting U, Sperl W, Mayr JA, Maier EM. Mutations in TTC19: expanding the molecular, clinical and biochemical phenotype. Orphanet J Rare Dis 2015; 10:40. [PMID: 25887401 PMCID: PMC4422538 DOI: 10.1186/s13023-015-0254-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/15/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND TTC19 deficiency is a progressive neurodegenerative disease associated with isolated mitochondrial respiratory chain (MRC) complex III deficiency and loss-of-function mutations in the TT19 gene in the few patients reported so far. METHODS We performed exome sequencing and selective mutational analysis of TTC19, respectively, in patients from three unrelated families presenting with initially unspecific clinical signs of muscular hypotonia and global developmental delay followed by regression, ataxia, loss of speech, and rapid neurological deterioration. One patient showed severe lactic acidosis at the neonatal age and during intercurrent illness. RESULTS We identified homozygous mutations in all three index cases, in two families novel missense mutations (c.544 T > C/p.Leu185Pro; c.917 T > C/p.Leu324Pro). The younger sister of the severely affected patient 3 showed only mild delay of motor skills and muscular hypotonia so far but is also homozygous for the same mutation. Notably, one patient revealed normal activities of MRC complex III in two independent muscle biopsies. Neuroimaging of the severely affected patients demonstrated lesions in putamen and caudate nuclei, cerebellar atrophy, and the unusual finding of hypertrophic olivary nuclei degeneration. Reviewing the literature revealed striking similarities regarding neuroimaging and clinical course in pediatric patients with TTC19 deficiency: patterns consistent with Leigh or Leigh-like syndrome were found in almost all, hypertrophic olivary nucleus degeneration in all patients reported so far. The clinical course in pediatric patients is characterized by an initially unspecific developmental delay, followed by regression, progressive signs and symptoms of cerebellar, basal ganglia and brainstem affection, especially loss of speech and ataxia. Subsequently, neurological deterioration leading to a vegetative state occurs. CONCLUSIONS Our findings add to the phenotypic, genetic, and biochemical spectrum of TTC19 deficiency. However, TTC19 deficient patients do show characteristic clinical and neuroimaging features, which may facilitate diagnosis of this yet rare disorder. Normal MRC complex III activity does not exclude the diagnosis.
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Affiliation(s)
- Johannes Koch
- Department of Pediatrics, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Peter Freisinger
- Department of Pediatrics Kreisklinken Reutlingen, Steinenbergstr. 31, 72764, Reutlingen, Germany.
| | - René G Feichtinger
- Department of Pediatrics, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Franz A Zimmermann
- Department of Pediatrics, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Christian Rauscher
- Department of Pediatrics, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Hans P Wagentristl
- Department of Pediatrics, Krankenhaus der Barmherzigen Brueder, Esterhazystr. 26, 7000, Eisenstadt, Austria.
| | - Vassiliki Konstantopoulou
- Department of Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Rainer Seidl
- Department of Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Tobias B Haack
- Institute of Human Genetics, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany. .,Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität München, Trogerstr. 32/3, 81675, Munich, Germany.
| | - Holger Prokisch
- Institute of Human Genetics, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany. .,Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität München, Trogerstr. 32/3, 81675, Munich, Germany.
| | - Uwe Ahting
- Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität München, Trogerstr. 32/3, 81675, Munich, Germany.
| | - Wolfgang Sperl
- Department of Pediatrics, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Johannes A Mayr
- Department of Pediatrics, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Esther M Maier
- Department of Pediatrics, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020, Salzburg, Austria. .,Present affiliation: Dr. von Hauner Children's Hospital, University of Munich, Lindwurmstr. 4, 80337, Munich, Germany.
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Tartaglione T, Izzo G, Alexandre A, Botto A, Di Lella GM, Gaudino S, Caldarelli M, Colosimo C. MRI findings of olivary degeneration after surgery for posterior fossa tumours in children: incidence, time course and correlation with tumour grading. Radiol Med 2015; 120:474-82. [PMID: 25572537 DOI: 10.1007/s11547-014-0477-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/16/2014] [Indexed: 01/12/2023]
Abstract
PURPOSE Olivary degeneration is due to many posterior cranial fossa (PCF) lesions affecting the dentato-rubro-olivary pathway, also known as Guillain-Mollaret triangle. Triangle damage results in hyperexcitation and consequently in hypertrophy of the inferior olivary nucleus (ION). The aim of our study was to evaluate the incidence of magnetic resonance (MR) imaging changes in the ION after surgery in a large cohort of paediatric patients and to determine their correlation with tumour grade. MATERIALS AND METHODS We retrospectively evaluated 58 patients treated surgically for PCF tumours who underwent MR imaging between 2007 and 2014, 1 week to 5 years after surgery. Histopathology revealed 29 medulloblastomas (WHO IV), 6 ependymomas (WHO II), 2 anaplastic ependymomas (WHO III) and 21 pilocytic astrocytomas (WHO I). ION MR imaging changes were correlated with surgery-to-MR interval and with tumour grading. RESULTS ION MR imaging changes were observed in 19/64 (33 %), and all consisted of T2 signal alterations, 15 bilateral and four unilateral, with dentate nucleus damage in all cases. Olivary enlargement was observed in few cases only (7/19). ION T2 hyperintensity was always present between 1 and 6 months after surgery with a trend to decrease, becoming faint after 1 year. The Fisher test demonstrated a significant (p = 0.005) correlation between ION MR imaging changes and high tumour grade. CONCLUSIONS Our results demonstrate that olivary degeneration, with or without hypertrophy, is a relatively frequent consequence of posterior fossa surgery, particularly in children treated for high-grade tumours. Knowledge of this condition can prevent misdiagnoses and unnecessary investigations.
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Affiliation(s)
- Tommaso Tartaglione
- Istituto di Radiologia - Dipartimento di Bioimmagini e Scienze Radiologiche, Rome, Italy
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Zhang M, Ye G, Deng L, Xu S, Wang Y. A case of hypertrophic olivary degeneration after resection of cavernomas of the brain stem and review of the literature. Neuropsychiatr Dis Treat 2015; 11:2613-8. [PMID: 26504394 PMCID: PMC4605241 DOI: 10.2147/ndt.s90549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hypertrophic olivary degeneration is a transsynaptic form of degeneration, which is also a result of primary or secondary lesion and can damage the dento-rubro-olivary pathway. The dento-rubro-olivary pathway was first described by Guillain and Mollaret and is referred to as "the triangle of Guillain and Mollaret". Multiple factors can destroy the dento-rubro-olivary pathway, such as surgical operation, hemorrhage, tumor, trauma, inflammation, demyelination, degeneration, and radiation damage. All of the above factors can result in delayed hypertrophic olivary degeneration. Articles related to this disease cover etiology, clinical presentation, pathology changes, etc. However, to our knowledge, there has been no literature reporting the use of diffusion tensor imaging and diffusion tensor tractography to improve the diagnosis of hypertrophic olivary degeneration following resection of cavernomas in the brain stem. Herein, we report a case who was diagnosed with hypertrophic olivary degeneration following resection of cavernomas of the brain stem, verify the significance of diffusion tensor imaging and diffusion tensor tractography, and review previous literature. The development of imageology promotes and improves hypertrophic olivary degeneration diagnosis and differential diagnosis.
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Affiliation(s)
- Meng Zhang
- Department of Neurosurgery, Qi Lu Hospital, Shandong University, Jinan, People's Republic of China
| | - Gengfan Ye
- Department of Neurosurgery, Qi Lu Hospital, Shandong University, Jinan, People's Republic of China
| | - Lin Deng
- Department of Neurosurgery, Qi Lu Hospital, Shandong University, Jinan, People's Republic of China
| | - Shuo Xu
- Department of Neurosurgery, Qi Lu Hospital, Shandong University, Jinan, People's Republic of China
| | - Yunyan Wang
- Department of Neurosurgery, Qi Lu Hospital, Shandong University, Jinan, People's Republic of China
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Orman G, Bosemani T, Jallo GI, Huisman TAGM, Poretti A. Hypertrophic olivary degeneration in a child following midbrain tumor resection: longitudinal diffusion tensor imaging studies. J Neurosurg Pediatr 2014; 13:408-13. [PMID: 24527860 DOI: 10.3171/2014.1.peds13490] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hypertrophic olivary degeneration (HOD) is a dynamic process caused by disruptive lesions affecting components of the Guillain-Mollaret triangle (GMT). The authors applied diffusion tensor imaging (DTI) to investigate longitudinal changes of the GMT components in a child with HOD after neurosurgery for a midbrain tumor. Diffusion tensor imaging data were acquired on a 1.5-T MRI scanner using a balanced pair of diffusion gradients along 20 noncollinear directions 1 day and 3, 6, and 9 months after surgery. Measurements from regions of interest (ROIs) were sampled in the affected inferior olivary nucleus, ipsilateral red nucleus, and contralateral superior and inferior cerebellar peduncles and dentate nucleus. For each ROI, fractional anisotropy and the mean, axial, and radial diffusivities were calculated. In the affected inferior olivary nucleus, the authors found a decrease in fractional anisotropy and an increase in mean, axial, and radial diffusivities 3 months after surgery, while 3 months later fractional anisotropy increased and diffusivities decreased. For all other GMT components, changes in DTI scalars were less pronounced, and fractional anisotropy mildly decreased over time. A detailed analysis of longitudinal DTI scalars in the various GMT components may shed light on a better understanding of the dynamic complex histopathological processes occurring in pediatric HOD over time.
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Affiliation(s)
- Gunes Orman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science; and
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Bindu PS, Taly AB, Sonam K, Govindaraju C, Arvinda HR, Gayathri N, Bharath MMS, Ranjith D, Nagappa M, Sinha S, Khan NA, Thangaraj K. Bilateral hypertrophic olivary nucleus degeneration on magnetic resonance imaging in children with Leigh and Leigh-like syndrome. Br J Radiol 2014; 87:20130478. [PMID: 24470583 DOI: 10.1259/bjr.20130478] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Bilateral hypertrophic olivary degeneration on brain MRI has been reported in a few metabolic, genetic and neurodegenerative disorders, including mitochondrial disorders. In this report, we sought to analyse whether bilateral symmetrical inferior olivary nucleus hypertrophy is specifically associated with mitochondrial disorders in children. METHODS This retrospective study included 125 children (mean age, 7.6 ± 5 years; male:female, 2.6:1) diagnosed with various metabolic and genetic disorders during 2005-2012. The routine MRI sequences (T1 weighted, T2 weighted and fluid-attenuated inversion-recovery sequences) were analysed for the presence of bilateral symmetrical olivary hypertrophy and central tegmental tract or dentate nuclei signal changes. The other imaging findings and the final diagnoses were noted. RESULTS The cohort included patients with Leigh and Leigh-like syndrome (n = 25), other mitochondrial diseases (n = 25), Wilson disease (n = 40), Type 1 glutaric aciduria (n = 14), maple syrup urine disease (n = 13), giant axonal neuropathy (n = 5) and L-2 hydroxy glutaric aciduria (n = 3). Bilateral inferior olivary nucleus hypertrophy was noted in 10 patients, all of whom belonged to the Leigh and Leigh-like syndrome group. CONCLUSION Bilateral hypertrophic olivary degeneration on MRI is relatively often, but not routinely, seen in children with Leigh and Leigh-like syndrome. Early detection of this finding by radiologists and physicians may facilitate targeted metabolic testing in these children. ADVANCES IN KNOWLEDGE This article highlights the occurrence of bilateral hypertrophic olivary nucleus degeneration on MRI in children with Leigh and Leigh-like syndrome, compared with other metabolic disorders.
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Affiliation(s)
- P S Bindu
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Meoded A, Poretti A, Ilica AT, Perez R, Jallo G, Burger PC, Huisman TAGM, Izbudak I. Diffusion tensor imaging in a child with hypertrophic olivary degeneration. THE CEREBELLUM 2014; 12:469-74. [PMID: 23307661 DOI: 10.1007/s12311-013-0448-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypertrophic olivary degeneration (HOD) is caused by disruptive lesions affecting components of the Guillain-Mollaret triangle (GMT). We present conventional magnetic resonance and diffusion tensor imaging (DTI) findings in a 6-year-old girl with HOD after surgery for a midbrain pilocytic astrocytoma. To our knowledge, this is the first dedicated DTI analysis of GMT in a child with HOD in the literature. In our patient, we found higher fractional anisotropy (FA) and axial diffusivity values of the inferior olivary nucleus (ION) and lower FA, but higher radial diffusivity (RD) values of all other GMT components compared to age-matched controls. Increased FA values of the ION may be explained by increased packing of white matter fibers. However, associated hyperintense T2 signal is contradictory and the association between increased FA values and hyperintense T2 signal remains unclear. Low FA and high RD values of the other GMT components likely reflect demyelination with axonal degeneration and correlate well with histopathological findings.
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Affiliation(s)
- Avner Meoded
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287-0842, USA
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Pandey P, Westbroek EM, Gooderham PA, Steinberg GK. Cavernous malformation of brainstem, thalamus, and basal ganglia: a series of 176 patients. Neurosurgery 2013; 72:573-89; discussion 588-9. [PMID: 23262564 DOI: 10.1227/neu.0b013e318283c9c2] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cavernous malformations (CMs) in deep locations account for 9% to 35% of brain malformations and are surgically challenging. OBJECTIVE To study the clinical features and outcomes following surgery for deep CMs and the complication of hypertrophic olivary degeneration (HOD). METHODS Clinical records, radiological findings, operative details, and complications of 176 patients with deep CMs were reviewed retrospectively. RESULTS Of 176 patients with 179 CMs, 136 CMs were in the brainstem, 27 in the basal ganglia, and 16 in the thalamus. Cranial nerve deficits (51.1%), hemiparesis (40.9%), numbness (34.7%), and cerebellar symptoms (38.6%) presented most commonly. Hemorrhage presented in 172 patients (70 single, 102 multiple). The annual retrospective hemorrhage rate was 5.1% (assuming CMs are congenital with uniform hemorrhage risk throughout life); the rebleed rate was 31.5%/patient per year. Surgical approach depended on the proximity of the CM to the pial or ependymal surface. Postoperatively, 121 patients (68.8%) had no new neurological deficits. Follow-up occurred in 170 patients. Delayed postoperative HOD developed in 9/134 (6.7%) patients with brainstem CMs. HOD occurred predominantly following surgery for pontine CMs (9/10 patients). Three patients with HOD had palatal myoclonus, nystagmus, and oscillopsia, whereas 1 patient each had limb tremor and hemiballismus. At follow-up, 105 patients (61.8%) improved, 44 (25.9%) were unchanged, and 19 (11.2%) worsened neurologically. Good preoperative modified Rankin Score (98.2% vs 54.5%, P = .001) and single hemorrhage (89% vs 77.3%, P < .05) were predictive of good long-term outcome. CONCLUSION Symptomatic deep CMs can be resected with acceptable morbidity and outcomes. Good preoperative modified Rankin Score and single hemorrhage are predictors of good long-term outcome.
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Affiliation(s)
- Paritosh Pandey
- Department of Neurosurgery, Stanford Stroke Center and Stanford Institute for Neuro-Innovation and Translational Neurosciences, Stanford University School of Medicine, Stanford, CA, USA
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Patay Z, Enterkin J, Harreld JH, Yuan Y, Löbel U, Rumboldt Z, Khan R, Boop F. MR imaging evaluation of inferior olivary nuclei: comparison of postoperative subjects with and without posterior fossa syndrome. AJNR Am J Neuroradiol 2013; 35:797-802. [PMID: 24184519 DOI: 10.3174/ajnr.a3762] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Posterior fossa syndrome is a severe postoperative complication occurring in up to 29% of children undergoing posterior fossa tumor resection; it is most likely caused by bilateral damage to the proximal efferent cerebellar pathways, whose fibers contribute to the Guillain-Mollaret triangle. When the triangle is disrupted, hypertrophic olivary degeneration develops. We hypothesized that MR imaging patterns of inferior olivary nucleus changes reflect patterns of damage to the proximal efferent cerebellar pathways and show association with clinical findings, in particular the presence or absence of posterior fossa syndrome. MATERIALS AND METHODS We performed blinded, randomized longitudinal MR imaging analyses of the inferior olivary nuclei of 12 children with and 12 without posterior fossa syndrome after surgery for midline intraventricular tumor in the posterior fossa. The Fisher exact test was performed to investigate the association between posterior fossa syndrome and hypertrophic olivary degeneration on MR imaging. The sensitivity and specificity of MR imaging findings of bilateral hypertrophic olivary degeneration for posterior fossa syndrome were measured. RESULTS Of the 12 patients with posterior fossa syndrome, 9 had bilateral inferior olivary nucleus abnormalities. The 12 patients without posterior fossa syndrome had either unilateral or no inferior olivary nucleus abnormalities. The association of posterior fossa syndrome and hypertrophic olivary degeneration was statistically significant (P < .0001). CONCLUSIONS Hypertrophic olivary degeneration may be a surrogate imaging indicator for damage to the contralateral proximal efferent cerebellar pathway. In the appropriate clinical setting, bilateral hypertrophic olivary degeneration may be a sensitive and specific indicator of posterior fossa syndrome.
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Affiliation(s)
- Z Patay
- From the Departments of Radiological Sciences (Z.P., J.H.H., U.L.)
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Shinohara Y, Kinoshita T, Kinoshita F, Kaminou T, Watanabe T, Ogawa T. Hypertrophic olivary degeneration after surgical resection of brain tumors. Acta Radiol 2013; 54:462-6. [PMID: 23486559 DOI: 10.1258/ar.2012.120537] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hypertrophic olivary degeneration (HOD) can be seen as high signal intensity with enlargement of the inferior olivary nucleus (ION) on T2-weighted magnetic resonance (MR) images 4-6 months after injury of the Guillain-Mollaret triangle. To the best of our knowledge, there has been no systematic evaluation with regard to the relationship between neurosurgical intervention affecting this pathway and the appearance of HOD. PURPOSE To evaluate MR findings of HOD after surgical resection of brain tumors with the temporal evolution in focus. MATERIAL AND METHODS MR images of seven patients that showed signal changes in the ION after surgical resection of brain tumors in the posterior fossa were retrospectively reviewed. T1-weighted imaging with and without gadolinium (Gd) contrast enhancement and T2-weighted imaging were performed in all patients before and after surgery. RESULTS Before surgery, no patient had a signal change in the ION. T2-high signal intensity of the ION initially appeared 5 days to 2.5 months after surgery. Five patients showed enlargement of the ION with T2-high signal intensity 11 days to 3.5 months after surgery: three patients showed the enlargement of the ION subsequent to the T2-signal change on serial follow-up MR images. On Gd-enhanced T1-weighted images, there was no enhancement at the ION in any patient. Each signal change of the ION was consistent with HOD, according to the relationship between the resection site of the tumor and the Guillain-Mollaret triangle on follow-up MRI. CONCLUSION HOD can be caused after neurosurgical intervention of brain tumors involving the Guillain-Mollaret triangle. It is important for radiologists to distinguish HOD from tumor recurrence.
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Affiliation(s)
- Yuki Shinohara
- Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Tottori University, Yonago
| | - Toshibumi Kinoshita
- Department of Radiology, Research Institute of Brain and Blood Vessels, Akita
| | - Fumiko Kinoshita
- Department of Radiology, Research Institute of Brain and Blood Vessels, Akita
| | - Toshio Kaminou
- Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Tottori University, Yonago
| | - Takashi Watanabe
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Toshihide Ogawa
- Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Tottori University, Yonago
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Yun JH, Ahn JS, Park JC, Kwon DH, Kwun BD, Kim CJ. Hypertrophic olivary degeneration following surgical resection or gamma knife radiosurgery of brainstem cavernous malformations: an 11-case series and a review of literature. Acta Neurochir (Wien) 2013; 155:469-76. [PMID: 23224379 DOI: 10.1007/s00701-012-1567-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 11/13/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND We describe 11 patients with hypertrophic olivary degeneration (HOD) after surgical resection or gamma knife radiosurgery for brainstem cavernous malformations. In addition, we statistically analyzed the predicting factors associated with the development of HOD. METHODS From January 2001 to May 2011, a total of 73 patients (30 in the surgical group and 43 in the radiosurgery group) with brainstem cavernous malformations were treated in our institute. Of them, 11 patients (incidence: 15 %) developed HOD with high signal intensity on T2-weighted MRI during follow-up. The predicting factors (location, size, age, and treatment method) associated with the development of HOD were statistically analyzed. RESULTS Among the 11 HOD patients, seven patients received surgical resection and four patients received gamma knife radiosurgery. Six patients had bilateral HOD and the remaining five patients had unilateral HOD. Overall HOD-associated symptoms presented in four patients, including three palatal tremors and one ataxia. In all four patients with symptoms, these symptoms disappeared incompletely within the clinical follow-up period. The size of the cavernous malformation, age of patient, and treatment methods were not significantly correlated with the development of HOD. A significantly higher incidence of HOD was associated with midbrain cavernous malformations than with pontine or medulla cavernous malformations. CONCLUSIONS HOD should be recognized as a non-infrequent complication of surgical resection or gamma knife radiosurgery within the brainstem, especially for midbrain cavernous malformations. In addition, to the best of our knowledge, this is the first report on HOD development after radiosurgery.
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Affiliation(s)
- Jung-Ho Yun
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2 dong, Songpa-gu, Seoul, 138-736, South Korea
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Otto J, Guenther P, Hoffmann KT. Bilateral hypertrophic olivary degeneration in Wilson disease. Korean J Radiol 2013; 14:316-20. [PMID: 23482821 PMCID: PMC3590346 DOI: 10.3348/kjr.2013.14.2.316] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 02/24/2012] [Indexed: 11/18/2022] Open
Abstract
Hypertrophic olivary degeneration resulting from lesions of the dento-rubro-olivary pathway, also called Guillain-Mollaret-triangle, has been described previously in a number of cases. Reports about bilateral hypertrophic olivary degeneration of the inferior olivary nuclei are very limited, and the magnetic resonance imaging findings of hypertrophic olivary degeneration in Wilson disease have not yet been described to the best of our knowledge. Herein, we present the first report of bilateral hypertrophic olivary degeneration diagnosed by magnetic resonance imaging in a patient suffering from Wilson disease.
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Affiliation(s)
- Josephin Otto
- Department of Neuroradiology, Leipzig University Hospital, Leipzig 04103, Germany.
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Sanverdi SE, Oguz KK, Haliloglu G. Hypertrophic olivary degeneration in children: four new cases and a review of the literature with an emphasis on the MRI findings. Br J Radiol 2012; 85:511-6. [PMID: 22337689 DOI: 10.1259/bjr/60727602] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Injury to the dentato-rubro-olivary pathway causes hypertrophy and enlargement of the inferior olivary nuclei, which is called hypertrophic olivary degeneration (HOD). To date, adult cases of HOD have usually been reported, and there are only a few individual paediatric cases with limited radiological emphasis in the literature. We present the clinical and MRI findings of four new paediatric cases with HOD. Three of the patients had a posterior fossa surgery, and one did not have an identifiable cause.
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Affiliation(s)
- S E Sanverdi
- Neuroradiology Division, Radiology Department School of Medicine, Hacettepe University, Ankara, Turkey.
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19
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Hypertrophic olivary degeneration after pontine hemorrhage. Neuroradiology 2011; 54:413-5. [PMID: 21643689 DOI: 10.1007/s00234-011-0897-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
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20
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Gatlin JL, Wineman R, Schlakman B, Buciuc R, Khan M. Hypertrophic olivary degeneration after resection of a pontine cavernous malformation: a case report. J Radiol Case Rep 2011; 5:24-9. [PMID: 22470783 DOI: 10.3941/jrcr.v5i3.603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
We report the case of a 35 year old African American female who developed hypertrophic olivary degeneration secondary to resection of a pontine cavernous malformation. The patient initially complained of headaches and diplopia. Unenhanced computed tomography (CT) and magnetic resonance images (MRI) of the brain revealed a left pontine cavernous malformation with scattered foci of recent and remote hemorrhage. The patient subsequently underwent surgical resection of the lesion. Follow up MRI 7 months post surgery demonstrated hypertrophy and T2 signal hyperintensity in the ipsilateral inferior olivary nucleus secondary to hypertrophic olivary degeneration. Familiarity with this diagnosis and its imaging characteristics is required of the radiologist to prevent erroneous diagnoses of other pathology.
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Affiliation(s)
- Joseph L Gatlin
- Department of Radiology-division of Neuroradiology, University of Mississippi School of Medicine, Jackson, MS 39202, USA.
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Affiliation(s)
- Lorraine Ash
- Department of Radiology University of Michigan Health Systems, Division of Neuroradiology, Ann Arbor, Michigan, USA.
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Hypertrophic olivary degeneration after surgical removal of cavernous malformations of the brain stem: report of four cases and review of the literature. Acta Neurochir (Wien) 2008; 150:149-56; discussion 156. [PMID: 18166990 DOI: 10.1007/s00701-007-1470-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Accepted: 09/11/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hypertrophic olivary degeneration (HOD) is a pathological phenomenon that occurs after injury to the dentato-olivary pathway. Its hallmarks include hypertrophy of the olive with increased T2 signal intensity on magnetic resonance imaging, and it often manifests with palatal tremor and oscillopsia clinically. METHOD We report the cases of four patients who developed delayed HOD after surgical resection of pontine lesions. FINDINGS We discuss the anatomical and pathological details of this disease and review the few other reported cases of HOD after resection of lesions within the brainstem. CONCLUSIONS HOD should be recognized as a possible complication of surgery within the brainstem and must be diagnosed promptly so that patients can be appropriately counseled and symptoms can be treated.
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Akar S, Drappatz J, Hsu L, Blinder RA, Black PM, Kesari S. Hypertrophic olivary degeneration after resection of a cerebellar tumor. J Neurooncol 2008; 87:341-5. [PMID: 18217209 DOI: 10.1007/s11060-008-9523-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 01/02/2008] [Indexed: 01/07/2023]
Abstract
We report a case of hypertrophic olivary degeneration due to cerebellar surgery for a low-grade tumor. A 27-year-old female presented with right-sided paresthesias and intermittent leg paresis following a right cerebellar resection of a tumor 2 weeks prior. One month later, her symptoms remained stable while her neurological examination demonstrated slight right hemi-body hypoesthesia and subtle appendicular ataxia in her right upper extremity. An MRI scan revealed a hypertrophied left anterolateral medulla with increased T2 signal and no diffusion abnormality. The T2 hyperintensity and hypertrophy slowly resolved and she clinically improved without further intervention. Hypertrophic olivary degeneration may be mistaken for tumor progression, post-operative vasculopathy or granulation tissue and should be considered in patients undergoing cerebellar surgery.
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Affiliation(s)
- Serra Akar
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, SW460, 44 Binney Street, Boston, MA 02115, USA
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Harter DH, Davis A. Hypertrophic olivary degeneration after resection of a pontine cavernoma. Case illustration. J Neurosurg 2004; 100:717. [PMID: 15070130 DOI: 10.3171/jns.2004.100.4.0717] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- David H Harter
- Department of Neurosurgery, New York Medical College, Valhalla, New York 10595, USA.
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Tsui EY, Cheung YK, Mok CK, Yuen MK, Chan JH. Hypertrophic olivary degeneration following surgical excision of brainstem cavernous hemangioma: a case report. Clin Imaging 1999; 23:215-7. [PMID: 10631896 DOI: 10.1016/s0899-7071(99)00147-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hypertrophic olivary degeneration (HOD) is a rare type of neuronal degeneration involving the dento-rubo-olivary pathway. It is distinguished from other types of neuronal degeneration in that hypertrophy, rather than atrophy, takes place in the neurons in the inferior olivary nucleus. Prior to the invention of Magnetic Resonance Imaging (MRI), HOD was difficult to be detected, and a firm diagnosis could only be made at autopsy. We present a case of bilateral HOD following surgical excision of a cavernous hemangioma in the brainstem. The literature and imaging findings of this uncommon condition are reviewed.
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Affiliation(s)
- E Y Tsui
- Department of Radiology, Tuen Mun Hospital, Hong Kong
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