1408 - Managing Hypertrophic Olivary Degeneration (HOD) Following Cerebrovascular Accident: A Case Report

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

Robert O. Emeh, BS

Medical Student
Howard University College of Medicine
Washington, District of Columbia, United States
AK

Ashkan Khosravi, MD

Resident Doctor
Baylor Scott & White Institute for Rehabilitation
Dallas, Texas, United States

Co-Author(s)

HP

Helen Patel, MD

PM&R Attending Doctor
Baylor Scott & White Institute for Rehabilitation
Dallas, Texas, United States

Case Diagnosis: Hypertrophic Olivary Degeneration (HOD) secondary to a perforator infarction affecting the paramedian aspect of the right pontomedullary junction.

Case Description: An 85-year-old male with a history of hypertension, hyperlipidemia, statin-induced pancreatitis, coronary artery disease, and a 1-year-old cerebral vascular accident (CVA) presented in an acute-care facility with worsening left leg weakness. Despite improvement in right facial droop, dysphagia, vertigo and voice hoarseness 1-year post-CVA, the patient experienced progressively worse left leg weakness, falls, and sensory disturbances, prompting evaluation. Physical examination revealed left leg weakness, tremors in bilateral upper extremities, dysmetria, and hemisensory loss. Imaging studies, including brain and lumbar MRI, confirmed hypertrophic olivary degeneration attributed to the pontomedullary infarction. To treat the symptoms of HOD, the patient was admitted to inpatient rehabilitation. The patient's overall rehabilitation plan included gait training, strengthening exercises, and coordination activities targeting HOD-related deficits.

Discussions: The rarity of HOD as a complication of a pontomedullary infarction presents unique challenges in rehabilitation. Symptom control for HOD-related symptoms like palatal tremors are challenging, with limited response to medications. Management of HOD requires a collaborative approach involving neurology, physical medicine and rehabilitation (PM&R), physical therapy, occupational therapy, and speech therapy.

Conclusions: This case underscores the importance of recognizing HOD as a potential complication of a pontomedullary infarction and highlights the challenges in symptom management and rehabilitation. While the prognosis for HOD is variable, ongoing multidisciplinary care remains crucial. The case also emphasizes the need for long-term follow-up to monitor radiological progression and exclude alternative diagnoses. The collaboration between Neurology, PM&R, PT, OT, and ST is paramount in optimizing functional outcomes and quality of life for patients with complex post-CVA complications such as HOD. This report contributes valuable insights into the intricate management of HOD within the realm of stroke rehabilitation.