{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:46:31Z","timestamp":1791812791365,"version":"4.3.4"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 3","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hypertrophic olivary degeneration (HOD) is a delayed trans-synaptic consequence of injury to the dentato-rubro-olivary pathway \u2013 the Guillain-Mollaret triangle (GMT) \u2013 and represents one of the few conditions in which the inferior olivary nucleus (ION), a pivotal node of the olivopontocerebellar system, paradoxically enlarges rather than atrophies following disconnection. Its peak magnetic resonance imaging (MRI) appearance closely mimics a primary brainstem neoplasm, and failure to recognize it has led to unnecessary biopsy in documented cases. We report a case of a 79-year-old man with uncontrolled hypertension who developed palatal tremor and contralateral cerebellar ataxia 7 months after a spontaneous left cerebellar hemorrhage. Brain MRI demonstrated T2\/fluid attenuation inversion recovery hyperintensity with hypertrophy of the right ION, blooming at the left dentate nucleus, and no restricted diffusion \u2013 the full diagnostic triad of HOD, established on a single examination. Neoplasm was confidently excluded without biopsy. This case illustrates that systematic, anatomy-guided interpretation of multi-sequence MRI \u2013 anchored by knowledge of GMT connectivity \u2013 is sufficient for definitive HOD diagnosis from a single study, with particular relevance for elderly patients and resource-limited clinical settings in which olivary degeneration may otherwise be misattributed to recurrent cerebrovascular disease or primary malignancy.<\/jats:p>","DOI":"10.4103\/aam.aam_435_26","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T06:30:38Z","timestamp":1782887438000},"page":"S619-S622","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["When Degeneration Masquerades as Disease: Diagnosing Hypertrophic Olivary Degeneration on a Single Magnetic Resonance Imaging Examination in an Elderly Patient with Posterior Fossa Hemorrhage"],"prefix":"10.4103","volume":"25","author":[{"given":"Atul","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of Radiodiagnosis, Medanta, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pragya","family":"Chaturvedi","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Medanta, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shrea","family":"Gulati","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Medanta, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atishay","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Medanta, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"R1-20261012","doi-asserted-by":"crossref","first-page":"71","DOI":"10.5334\/jbr-btr.1065","article-title":"Imaging features of hypertrophic olivary degeneration","volume":"100","author":"Van Eetvelde","year":"2016","journal-title":"J Belg Soc Radiol"},{"key":"R2-20261012","doi-asserted-by":"crossref","first-page":"435","DOI":"10.4103\/ijri.IJRI_412_18","article-title":"Hypertrophic olivary degeneration: A case report","volume":"29","author":"\u00d6zdemir","year":"2019","journal-title":"Indian J Radiol Imaging"},{"key":"R3-20261012","first-page":"1073","article-title":"Hypertrophic olivary degeneration: Metaanalysis of the temporal evolution of MR findings","volume":"21","author":"Goyal","year":"2000","journal-title":"AJNR Am J Neuroradiol"},{"key":"R4-20261012","first-page":"388","article-title":"Bilateral hypertrophic olivary degeneration following brainstem insult: A retrospective review and examination of causative pathology","volume":"34","author":"Behzadi","year":"2021","journal-title":"Neuroradiol J"},{"key":"R5-20261012","doi-asserted-by":"crossref","first-page":"31262","DOI":"10.1038\/s41598-025-14912-1","article-title":"Clinical characteristics of hypertrophic olivary degeneration following brainstem or cerebellar hemorrhage","volume":"15","author":"Lin","year":"2025","journal-title":"Sci Rep"},{"key":"R6-20261012","doi-asserted-by":"crossref","first-page":"675123","DOI":"10.3389\/fneur.2021.675123","article-title":"Multicenter prospective analysis of hypertrophic olivary degeneration following infratentorial stroke (HOD-IS): Evaluation of disease epidemiology, clinical presentation, and MR-imaging aspects","volume":"12","author":"Schaller-Paule","year":"2021","journal-title":"Front Neurol"},{"key":"R7-20261012","doi-asserted-by":"crossref","first-page":"40","DOI":"10.5334\/tohm.188","article-title":"Palatal tremor \u2013 Pathophysiology, clinical features, investigations, management and future challenges","volume":"10","author":"Bhattacharjee","year":"2020","journal-title":"Tremor Other Hyperkinet Mov (N Y)"},{"key":"R8-20261012","doi-asserted-by":"crossref","first-page":"3480","DOI":"10.21037\/qims-21-1048","article-title":"Hypertrophic olivary degeneration: A description of four cases of and a literature analysis","volume":"12","author":"Gao","year":"2022","journal-title":"Quant Imaging Med Surg"},{"key":"R9-20261012","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.brainres.2019.04.024","article-title":"Hypertrophic olivary degeneration: A comprehensive review focusing on etiology","volume":"1718","author":"Wang","year":"2019","journal-title":"Brain Res"}],"container-title":["Annals of African Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_435_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:01:35Z","timestamp":1791810095000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_435_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,30]]},"references-count":9,"journal-issue":{"issue":"Suppl 3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aam.aam_435_26","relation":{},"ISSN":["1596-3519","0975-5764"],"issn-type":[{"value":"1596-3519","type":"print"},{"value":"0975-5764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,30]]},"assertion":[{"value":"2026-04-16","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-12","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}