Abstract: Hypertrophic olivary degeneration is relatively rare in clinical practice, with typical clinical manifestations including palatal myoclonus, ataxia, hoarseness, and ocular symptoms. Patients presenting with paroxysmal limb tremor as the prominent manifestation are even rarer, and such patients are prone to missed diagnosis and misdiagnosis. This article reports a case of hypertrophic olivary degeneration secondary to brainstem hemorrhage (involving the right pons and midbrain) presenting with prominent paroxysmal limb tremor, and describes its diagnosis, treatment, and follow-up. Combined with relevant literature, it discusses the clinical characteristics of such patients and summarizes the key points of its anatomical basis, imaging manifestations, diagnosis, and treatment. The aim is to enhance clinicians’ understanding of this disease and avoid missed diagnosis and misdiagnosis.

Key words: Hypertrophic olivary degeneration; Paroxysmal limb tremor; Brainstem hemorrhage; Diagnosis; Treatment

摘要： 肥大性下橄榄核变性在临床上较为罕见，其典型临床表现包括腭肌阵挛、共济失调、声音嘶哑和眼部症状，而以四肢阵发性震颤为突出表现的患者则更为罕见，此类患者易被漏诊或误诊。本文报道1例继发于脑干（右侧脑桥和中脑）出血、以四肢阵发性震颤为突出表现的肥大性下橄榄核变性患者，介绍其诊断、治疗及随访情况，并结合相关文献探讨此类患者的临床特点，总结其解剖基础、影像学表现、诊断与治疗要点，以提高临床医师对该病的认识，避免漏诊与误诊。

关键词: 肥大性下橄榄核变性; 四肢阵发性震颤; 脑干出血; 诊断; 治疗