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Meta-Analysis
. 2000 Jun-Jul;21(6):1073-7.

Hypertrophic olivary degeneration: metaanalysis of the temporal evolution of MR findings

M Goyal  1 , E Versnick, P Tuite, J S Cyr, W Kucharczyk, W Montanera, R Willinsky, D Mikulis
Affiliations
Meta-Analysis

Hypertrophic olivary degeneration: metaanalysis of the temporal evolution of MR findings

M Goyal et al. AJNR Am J Neuroradiol. 2000 Jun-Jul.

Abstract

Background and purpose: Hypertrophic olivary degeneration (HOD) is usually caused by a lesion in the triangle of Guillain and Mollaret and presents clinically as palatal tremor. Although the imaging features have been well described, the temporal course of hypertrophy and T2 signal increase in the inferior olivary nucleus (ION) has not been fully characterized. Our purpose was to evaluate the time course of MR imaging features of HOD caused by a lesion within the triangle of Guillain and Mollaret.

Methods: The temporal progression of HOD in 45 patients with symptomatic palatal tremor was obtained by extrapolation of combined MR imaging data from six patients treated at our institution and 39 patients reported in the literature. The MR examinations and reports were reviewed for presence of hyperintense signal in the ION on T2-weighted images, hypertrophy of the ION, and an inciting lesion in the triangle of Guillain and Mollaret. The interval between the MR examination and the inciting lesion was determined.

Results: Increased olivary signal on T2-weighted images first appeared 1 month after the inciting lesion and persisted for at least 3 to 4 years. Olivary hypertrophy initially developed 6 months after the acute event and resolved by 3 to 4 years.

Conclusion: Visible changes on MR images in the ION in patients with a lesion in the triangle of Guillain and Mollaret correlate well with the described sequential histopathologic findings.

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Figures

<sc>fig</sc> 1.
fig 1.
Time course of olivary hypertrophy. The data points indicate the presence or absence of hypertrophy based on MR findings as a function of time after onset of clinical symptoms. Note that there is a higher density of data points between 0.5 and 5 years for the hypertrophy present category, indicating a high likelihood of finding hypertrophy during this time frame. Also note the absence of hypertrophy both early and late in the course of the disease
<sc>fig</sc> 2.
fig 2.
Time course of T2 signal intensity changes in HOD. The data points indicate the presence or absence of increased signal on T2-weighted MR images as a function of time after onset of clinical symptoms. Note that increased T2 signal is observed very early in the course of the disease and that the signal increase persists indefinitely
<sc>fig</sc> 3.
fig 3.
General model of time course of hypertrophy and T2 signal intensity in HOD derived from figures 1 and 2. The negative slope in the dashed line is speculative, suggesting that the oliva becomes atrophic
<sc>fig</sc> 4.
fig 4.
MR examination, 20 months after pontine hemorrhage. Axial T2-weighted fast spin-echo image (TR/TE = 6000/92, echo train length = 12) at the level of the ION shows hypertrophy with hyperintensity of bilateral ION.fig 5. Follow-up axial T2-weighted fast spin-echo image (TR/TE = 5000/105, echo train length = 12) 49 months after hemorrhage into a pontine cavernoma shows hyperintensity in bilateral ION. No evidence of hypertrophy is present
<sc>fig</sc> 6.
fig 6.
Drawing shows the triangle of Guillain and Mollaret
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