EURORAD ESR

Case 9345

Olivary hypertrophic degeneration caused by mesencephalic haematoma involving the Guillain-Mollaret triangle

Author(s)
Babaker M, Cuvincuc V, Haller S, Vargas M-I, Lovblad K-O

Department of Neuroradiology, Hôpital Cantonal Universitaire de Genève, Geneva, Switzerland.
 
Patient
male, 64 year(s)
 
 
  • Figure 1
    Initial brain CT (2 hours after symptoms onset)

    Initial CT imaging shows a spontaneous hyperdensity in the right cerebral peduncle suggesting an acute haematoma.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT; Special Focus: Blood;
     
     
  • Figure 2
    Brain MR at 48h - coronal FLAIR

    Coronal FLAIR performed 48h after symptoms onset shows the ponto-mesencephalic haematoma surrounded by oedema.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Special Focus: Blood;
     
     
  • Figure 3
    Follow-up MR at 5 months - coronal FLAIR

    Follow-up coronal FLAIR shows pontomesencephalic haemorrhagic sequelae with a bilateral FLAIR hyperintensity and enlargement of the olivary nuclei, more obvious on the right side. Note: hypersignal of the middle...

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Special Focus: Ischaemia / Infarction;
     
     
  • Figure 4
    The Guillain-Mollaret triangle (superimposed on a T1-weighted image)

    Guillain-Mollaret triangle - the dentatorubral tract (purple) connects the red nucleus (red) and the contralateral dentate nucleus (blue), while the central tegmental tract (yellow) connects the red nucleus and the...

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR;
     
     
Initial CT imaging shows a spontaneous hyperdensity in the right cerebral peduncle suggesting an acute haematoma.
 
Coronal FLAIR performed 48h after symptoms onset shows the ponto-mesencephalic haematoma surrounded by oedema.
 
Follow-up coronal FLAIR shows pontomesencephalic haemorrhagic sequelae with a bilateral FLAIR hyperintensity and enlargement of the olivary nuclei, more obvious on the right side. Note: hypersignal of the middle cerebellar peduncles (probably wallerian degeneration).
 
Guillain-Mollaret triangle - the dentatorubral tract (purple) connects the red nucleus (red) and the contralateral dentate nucleus (blue), while the central tegmental tract (yellow) connects the red nucleus and the inferior olivary nucleus (green).
 
 
 
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