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Pradeep S, Grewal P, Jahan S, Raslau FD, Slevin JT. Pearls & Oy-sters: Progressive ataxia and palatal tremor: Imaging and disease course. Neurology 2020; 94:e1445-e1447. [PMID: 32107322 DOI: 10.1212/wnl.0000000000009178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Swati Pradeep
- From the Departments of Neurology (S.P., P.G., S.J., F.D.R., J.T.S.) and Radiology (F.D.R.), University of Kentucky; and VA Medical Center (J.T.S.), Lexington, KY
| | - Parneet Grewal
- From the Departments of Neurology (S.P., P.G., S.J., F.D.R., J.T.S.) and Radiology (F.D.R.), University of Kentucky; and VA Medical Center (J.T.S.), Lexington, KY.
| | - Samia Jahan
- From the Departments of Neurology (S.P., P.G., S.J., F.D.R., J.T.S.) and Radiology (F.D.R.), University of Kentucky; and VA Medical Center (J.T.S.), Lexington, KY
| | - Flavius D Raslau
- From the Departments of Neurology (S.P., P.G., S.J., F.D.R., J.T.S.) and Radiology (F.D.R.), University of Kentucky; and VA Medical Center (J.T.S.), Lexington, KY
| | - John T Slevin
- From the Departments of Neurology (S.P., P.G., S.J., F.D.R., J.T.S.) and Radiology (F.D.R.), University of Kentucky; and VA Medical Center (J.T.S.), Lexington, KY
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wein S, Yan B, Gaillard F. Hypertrophic olivary degeneration secondary to pontine haemorrhage. J Clin Neurosci 2015; 22:1213-4. [PMID: 25863998 DOI: 10.1016/j.jocn.2015.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 02/14/2015] [Indexed: 11/20/2022]
Abstract
We report a 58-year-old man who developed hyptertrophic olivary degeneration (HOD) after haemorrhage of a cavernous malformation in the pons. Lesions of the triangle of Guillain and Mollaret (the dentatorubro-olivary pathway) may lead to HOD, a secondary transsynaptic degeneration of the inferior olivary nucleus. HOD is considered unique because the degenerating olive initially becomes hypertrophic rather than atrophic. The primary lesion causing pathway interruption is often haemorrhage, either due to hypertension, trauma, surgery or, as in our patient, a vascular malformation such as a cavernoma. Ischaemia and demyelination can also occasionally be the inciting events. The classic clinical presentation of HOD is palatal myoclonus, although not all patients with HOD develop this symptom. The imaging features of HOD evolve through characteristic phases. The clue to the diagnosis of HOD is recognition of the distinct imaging stages and identification of a remote primary lesion in the triangle of Guillain and Mollaret. Familiarity with the classic imaging findings of this rare phenomenon is necessary in order to avoid misdiagnosis and prevent unnecessary intervention.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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