Hypertrophic olivary degeneration secondary to cerebrovascular disease

Background: Hypertrophic olivary degeneration (HOD) typically manifests after damage to brain stem structures. The onset of the disease associated with HOD is often hidden, and the diagnosis is often delayed or misdiagnosed, significantly increasing the economic burden on patients. However, reports on HOD are limited. This study comprehensively analyzed the clinical characteristics of HOD, specifically the vestibular function of patients with HOD, and provides a new direction for the diagnosis and treatment in this demographic. Methods: In this observational study, we collected clinical data on patients with HOD admitted to our hospital between 2022 and 2023.We compiled their clinical information, blood test results, imaging findings, and vestibular balance function, eye movements. Results: All patients exhibited varying degrees of vestibular dysfunction and balance cerebellar ataxia, palatal tremor (PT) or oculo-palatal tremor (OPT) and vestibular dysfunction, i.e. VOR impairment (or impairment of responses to high frequency rotatory acceleration) high-frequency semicircular canal injury were the most common. Conclusions: In patients with brainstem and cerebrovascular diseases in several years, clinicians should be vigilant for signs of palatal muscle tremors, nystagmus ocular-palatal tremor (OPT), and new visual changes. Additionally, efforts should be made to perform at least a bedside examination of eye alignement, nystagmus, eye movements and VOR enhance vestibular examination and improve the understanding of vestibular and nystagmus conditions, which can improve the early diagnosis rate. The prominence of damage degree in the semicircular canal at high frequencies is a particular concern. Combined with vestibular function and nystagmus, targeted rehabilitation and medication can improve patients' quality of life and reduce the risk of accidental falls.