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| 继发于脑血管病康复期的肥大性下橄榄核变性：10例病例系列报告及文献回顾 |
| Hypertrophic olivary degeneration following cerebrovascular disease during convalescence: Case series and review of literature |
| 投稿时间：2025-06-16 修订日期：2025-06-16 |
| DOI： |
| 中文关键词: 脑卒中康复期 肥大性下橄榄核变性 齿状核-红核-下橄榄环路 腭震颤 霍姆斯震颤 临床特征 康复治疗 |
| 英文关键词: Convalescence of cerebrovascular disease, Hypertrophic olivary degeneration, Dentato-Rubro-Olivary Pathway, Palatal tremor, Holmes" tremor. |
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| 中文摘要: |
| 目的 探讨继发于脑血管病康复期的肥大性下橄榄核变性（Hypertrophic olivary degeneration HOD）的症状、体征、发生机制、影像特点、诊断、治疗及预后。
方法 收集2019年1月-2024年4月在我院神经康复科住院治疗的10例HOD患者临床资料，分析其临床特征、影像学表现、治疗及预后并结合文献进行回顾。
结果 10例患者中2例为女性，8例为男性；7例患者继发于脑干出血，2例患者继发于脑干或小脑梗死，1例患者继发于小脑动静脉畸形导致的小脑出血；6例患者累及双侧下橄榄核，4例患者累及单侧下橄榄；5例患者有典型的腭震颤（palatal tremor PT）或霍姆斯震颤(Holmes' tremor HT)，其余患者无典型临床表现；10例患者的头颅核磁均可见延髓橄榄核体积增大，在T2WI和T2FLAIR呈高信号改变，1例肌阵挛患者口服氯硝西泮后症状减轻；经常规康复治疗后8例患者的改良Barthel指数（Modified Barthel Index MBI）、移动能力评分（Modified Rivermead Mobility Index MRMI）及Berg平衡量表(Berg Balance Scale BBS)评分均有提高，但整体日常生活能力差。
结论 位于脑干和小脑的Guillain-Mollaret三角（Guillain-Mollaret triangle GMT）损伤后容易继发HOD，使患者的康复过程变得更复杂，且容易被误诊和漏诊，其药物和康复治疗效果有限。 |
| 英文摘要: |
| Objective We present clinical data of 10 patients with hypertrophic olivary degeneration(HOD) to investigate the symptoms, signs, pathogenesis, imaging features, diagnosis, treatment and prognosis of the disease.
Methods Clinical data including primary disease, clinical presentation, imaging findings, treatment and rehabilitation rating scale scores, were collected and analyzed from patients who admitted to the Neurorehabilitation department and diagnosed with HOD from January 2019 to April 2024.
Results Among the 10 patients, 7 patients were secondary to brainstem hemorrhage, 2 patients were secondary to brainstem or cerebellar ischemic stroke, and 1 patient was secondary to vascular malformation. 6 patients showed bilateral HOD and 4 patients showed unilateral HOD. Only 5 patients had typical palatal tremor(PT) or Holmes' tremor(HT). The symptoms of myoclonus were alleviated in case 1 after Clonazepam treatment. The activity of daily living(ADL) of these patients were very difficult, but the Modified Barthel Index(MBI) of ADL and the scores of Berg Balance Scale(BBS) and Modified Rivermead Mobility Index (MRMI) were improved in 8 patients after rehabilitation.
Conclusion The lesions of the Guillain-Mollaret triangle (GMT) are prone to secondary HOD, which makes the rehabilitation process of patients more complicated. Its untypical manifestations make it easy to be misdiagnosed and missed, and the limited treatment results in a poor prognosis. |
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