case_images: PMC10863524_01
case_images: DROP. Solid arrows indicate the classic locations along the DROP to cause HOD: lesions at the DN, the denatorubral tract via the SCP, the RN, and the CTT. The dashed arrow indicates efferent fibers from the ION completing the GMT, decussating via the inferior cerebellar peduncle along the olivodentary tract to the contralateral RN; this tract is dashed because lesions here do not classically cause HOD. . ION, inferior olivary nucleus; GMT, Guillain-Mollaret triangle; DROP, dentato-rubro-olivary pathway; DN, dentate nucleus; RN, red nucleus; SCP, superior cerebellar peduncle; CTT, central tegmental tract; HOD, hypertrophic olivarian degeneration
case_images: cureus-0016-00000052251-i01.jpg
case_images: PMC10863524_01_cureus-0016-00000052251-i01.jpg
case_images: FIG1
case_images: MRI findings revealed a non-enhancing T2 hyperintense lesion in her right medulla oblongata suggestive of HOD, though the classical GMT pathway showed no apparent lesions (Figures 1 and Figure 2).
case_images: Imaging after initial symptom onset. Axial T2 (2A) and post-contrast MPRAGE T1 (2B) weighted images demonstrate mild enlargement of right ION, which is slightly hyperintense on T2 weighted images and hypointense on MPRAGE T1 weighted images. There was no contrast enhancement.. ION, inferior olivary nucleus
case_images: cureus-0016-00000052251-i02.jpg
case_images: PMC10863524_01_cureus-0016-00000052251-i02.jpg
case_images: FIG2
case_images: MRI findings revealed a non-enhancing T2 hyperintense lesion in her right medulla oblongata suggestive of HOD, though the classical GMT pathway showed no apparent lesions (Figures 1 and Figure 2).
case_images: Imaging two months post-initial symptom onset. Axial T2 weighted imaging two months after demonstrates no change.
case_images: cureus-0016-00000052251-i03.jpg
case_images: PMC10863524_01_cureus-0016-00000052251-i03.jpg
case_images: FIG3
case_images: T2 hyperintensity (Figure 3).