• Minxia Geng, Lulu Wang, Jiahao Xing, Shuang Li, Lulu Dong, Chao Jiang, and Tianjun Wang.
• Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.
• Medicine (Baltimore). 2023 Jan 13; 102 (2): e32681e32681.

RationaleHypertrophic subolivine degeneration (HOD) was destroyed by Guillain-Mollaret triangle (GMT) due to various injuries, resulting in anterograde cavity-like degeneration of the lower olive nucleus. In addition, the brain stem is related to the muscle coordination of the upper respiratory tract. Obstructive sleep apnea hypopnea syndrome may affect the respiratory center due to the injury of the brain stem. Brain stem hemorrhage damage GMT, resulting in transsynaptic neuronal degeneration. Clinical manifestations can be complex, and enhanced magnetic resonance imaging can be helpful in distinguishing them.Patient ConcernsHOD is a self-limiting disease with no effective treatment and a long course of disease. Most patients can improve their symptoms after symptomatic treatment, and some patients can relieve their symptoms by themselves after 3 to 4 years.Diagnosis InterventionsThe limbs wobble involuntarily. His clinical symptoms and signs are consistent with HOD. Imaging with a clear primary lesion confirmed HOD. After treatment with antiepileptic drugs, the patient's symptoms were relieved. Moreover, the patient had snoring and apnea, and respiratory sleep monitoring showed moderate obstructive sleep apnea hypopnea syndrome, which was treated with noninvasive ventilator.OutcomesAfter treatment with antiepileptic drugs and noninvasive ventilator, the patient's symptoms were significantly relieved.LessonsHOD is a rare clinical disorder. Therefore, for similar patients, more attention should be paid to early diagnosis and treatment to avoid missed diagnosis, misdiagnosis and unnecessary intervention measures. The diagnosis can be confirmed by primary disease, clinical symptoms, and imaging based on GMT.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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