Hypertrophic olivary degeneration (HOD) is a rare phenomenon in the dento-rubro-olivary pathway due to lesion or disruption of the fibers of the Guillain-Mollaret Triangle. Hemorrhage of pontine and midbrain cavernous angiomas rarely can lead to hypertrophic olivary degeneration (HOD) portending neurological deterioration and possible concomitant life-threatening complications; for this reason, it may define a poignant consideration in planning intervention.
57-year-old female with known midbrain-pontine cavernous angioma. For several years, the lesion was stable, as demonstrated by imaging follow-up until 10 months prior to presentation with falls, dysarthria and headache. Imaging demonstrated some decrease in size as well as blood product around the cavernous angioma suggesting interim period hemorrhage and interval development of unilateral hypertrophic olivary degeneration.
Herein, the literature regarding imaging recommendations for stable cavernous angioma in the midbrain-pontine junction is reviewed. The implication of hypertrophic olivary degeneration for patient outcome is discussed and a comment is made on how the development of HOD may impact management of the cavernous angioma.