Hypertensive encephalopathy and hypertrophic olivary degeneration
Prior cerebellar hemisphere and intraventricular haemorrhage.
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There is evidence of prior posterior fossa haemorrhage with residual haemosiderin staining along the left lateral wall of the fourth ventricle and subjacent cerebellar parenchyma. Note is made of changes in the right olivary nucleus consistent with hypertrophic olivary degeneration.
Multiple small susceptibility foci scattered predominantly through the basal ganglia, brainstem, and cerebellum are consistent with chronic hypertensive encephalopathy. High T2/FLAIR signal abnormalities scattered through the supratentorial white matter are consistent with chronic small vessel ischaemia. Prominent basal ganglia perivascular spaces and a right side old lacunar infarct.
This patient has long-standing and well-documented difficult to control hypertension. The distribution of microhaemorrhages is characteristic of hypertension, matching the distribution of larger haemorrhage. The prior left cerebellar hemisphere haemorrhage, involving the left dentate nucleus, is the cause of the right sided hypertrophic olivary degeneration (HOD).