脑桥出血继发肥大性下橄榄核变性患者临床特点分析

Analysis of the clinical characteristics of patients with hypertrophic inferior olivary nucleus degeneration secondary to pontine hemorrhage

目的探讨脑桥出血后继发肥大性下橄榄核变性(hypertrophic olivary degeneration,HOD)患者临床特征及其发生机制。方法收集2019年11至2022年12月巴彦淖尔市医院神经内科诊断的脑桥出血后继发HOD患者8例,其中男性6例,女性2例,年龄(53±7)岁,分析其临床特征、影像学表现、治疗及预后,并结合文献进行复习。结果8例患者中5例表现为腭肌痉挛,3例出现Holmes震颤(HT),2例出现垂直眼球浮动,1例未见明确新发症状体征。磁共振成像(MRI)表现为下橄榄核体积增大,T2WI和Flair呈高信号改变;头颅CT检查均显示脑桥被盖部出血。结论位于齿状核-红核-下橄榄核环路(亦称为Guillain-Mollaret triangle,GMT)的脑桥被盖部出血易继发HOD,推测出现HOD与HT的解剖学通路存在一定关系。

Objective To explore the clinical characteristics and the mechanisms of patients with secondary hypertrophic inferior olivary degeneration(hypertrophic olivary degeneration,HOD)after pontine hemorrhage.Methods Eight cases of HOD secondary to pontine hemorrhage diagnosed in the Department of Neurology of Bayannur City Hospital from November 2019 to December 2022,including 6 male patients and 2 female patients,with an average age of(53±7)years,were collected.Their clinical characteristics,imaging feature,treatment,and prognosis were analyzed retrospectively combined with the literature.Results Among the 8 patients with secondary HOD after pontine hemorrhage,5 patients had palatal tremor,3 patients were complicated with holmes tremor(HT),2 patients had vertical pendular nystagmus,and 1 patient had no clear signs of new symptoms.The magnetic resonance imaging(MRI)showed increased volume of the inferior olive nucleus and hyperintensities in T2WI and FLAIR.Brain CT scan showed hemorrhage in the dorsal part of pons in all cases.Conclusions The dorsal pontine hemorrhage located in the dentato-rubro-olivary pathway(also known as Guillain-Mollaret triangle,GMT)is prone to lead to HOD.We speculate that there is a certain relationship between the anatomical pathway of HOD and the anatomical pathway of HT.