Idiopathic bilateral hypertrophic olivary degeneration.

palatal myoclonus, tongue fasciculation and ataxic gait. MRI of the brain showed increased T2 and Fluid Attenuation Inversion recovery (FLAIR) signal intensities in the bilateral inferior olivary complex without diffusion restriction (figure 1). Midbrain, pons, and cerebral and cerebellar parenchyma were normal (figure 2). Imaging features were consistent with bilateral hypertrophic olivary degeneration. Hypertrophic olivary degeneration is a unique type of trans-synaptic neuronal degeneration caused by damage to the dentatorubral pathway or the triangle of Guillain and Mollaret (figure 3). Focal lesions like infarction, haemorrhage, demyelination and trauma involving this neuronal pathway lead to interruption, and following sequential pathological changes are described (table 1). Hypertrophic olivary degeneration is mostly bilateral, and half of bilateral cases may be implicated to primary neurodegenerative process. Our patient’s MRI revealed no abnormality involving Idiopathic bilateral hypertrophic olivary degeneration Manchikanti Venkatesh, Sunitha Vellathussery Chakkalakkoombil, Pradeep Pankajakshan Nair, Umar Basha Sowkar Images in...