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Hypertrophic olivary degeneration (HOD) is a rare form of transsynaptic degeneration and is the only type which occurs with hypertrophy rather than atrophy. It develops due to pathologies affecting conduction in the dentato-rubro-olivary pathway. Despite being the classic HOD-related findings, palatal tremor, Holmes tremor, nystagmus, and cerebellar ataxia are not usually present in patients. Most cases are asymptomatic, and HOD is incidentally detected on magnetic resonance imaging scans. This paper reports the case and imaging results of a 60-year-old male patient that presented with findings of acute infarction at the posterior aspect of the mesencephalon and pons and superior cerebellar peduncle following head trauma and developed right contralateral HOD. [ABSTRACT FROM AUTHOR]