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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
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Track density imaging of hypertrophic olivary degeneration from multiple sclerosis plaque

Michael J Hoch1, Sohae Chung2, Girish M Fatterpekar1

  • 1Department of Neuroradiology, New York University Langone Medical Center, New York, NY, USA.

BJR Case Reports
|November 22, 2018
PubMed

Insights

Track density imaging revealed changes in brainstem connectivity, aiding diagnosis of hypertrophic olivary degeneration in a multiple sclerosis patient. This technique helps characterize neurodegeneration by assessing lesion-induced pathway alterations.

Area of Science:

  • Neuroimaging
  • Neuroscience
  • Radiology

Background:

  • Relapsing-remitting multiple sclerosis (MS) can present with diverse neurological deficits.
  • Brainstem lesions in MS require accurate differentiation from other pathologies like hypertrophic olivary degeneration (HOD).
  • Distinguishing MS lesions from HOD is crucial for appropriate patient management and avoiding unnecessary treatments.

Observation:

  • A patient with MS developed ataxia and diplopia due to a pontine lesion affecting the superior cerebellar peduncle.
  • A subsequent lesion in the inferior medullary olive presented a diagnostic challenge, with MS lesion versus HOD as primary differentials.
  • Track density imaging (TDI) was employed to assess the integrity of the dentato-rubro-olivary pathway (Guillain-Mollaret triangle).

Findings:

  • TDI demonstrated altered integrity of the dentato-rubro-olivary pathway, consistent with HOD secondary to the antecedent MS lesion.
  • The findings supported HOD over a new MS lesion, infarct, or neoplasm.
  • The patient's olivary lesion showed involution on follow-up MRI without further intervention.

Implications:

  • Track density imaging offers detailed anatomical insights into brainstem connectivity.
  • TDI can be a valuable tool for characterizing neurodegeneration and differentiating lesion-induced changes in neurological disorders.
  • This case highlights the utility of advanced neuroimaging techniques in complex neurological cases, guiding clinical decision-making.

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