Objective To explore the clinical features of elderly onset olivopontocerebellar atrophy (OPCA). Methods The clinical data of 1 OPCA patient with elderly onset was analyzed retrospectively.Results This patient was female, 77 years old.The main clinical manifestations were frequent urination, nocturia, frequent uroschesis, walking instability, gait ataxia, stiff limbs, and associated with verbal not fluency, spit the word unclear.EMG showed the amplitude of compound muscle action potential of peroneal nerve in both side were reduced, the motor nerve conduction velocity ( MCV) was normal.The MCV of tibial nerve, ulnar nerve, median nerve in both side were normal.The sensory nerve conduction velocity ( SCV) of ulnar nerve in both side, median nerve in left side were normal.Somatosensory evoked potentials ( SEP) showed the deep sensory pathway of left upper limb and left lower limb were normal.The deep sensory pathway in cortex of right upper limb was suffered damage, and the deep sensory pathway of right lower limb was suffered damage.Brain MRI showed the diameters lines of each direct cerebellum in T1 WI sagittal and coronal were shortened.The ratio of pons and medulla oblongata line was significantly decreased. The radial lines of brainstem were significantly smaller than the ratio of anteroposterior diameter of fourth ventricle.It can found“cross sign” in pons in T2 WI.Conclusions The symptoms of OPCA are not typical in early stage.The main clinical manifestations are weakness in both lower limb and progressive cerebellar ataxia, and associated with dysautonomia.The brain MRI feature is “cross sign”.%目的：探讨老年起病橄榄体脑桥小脑萎缩（ OPCA）的临床特点。方法回顾性分析1例老年OPCA患者的临床资料。结果本例患者为女性，77岁。主要表现为尿频、夜尿增多、尿潴留、行走不稳、动作不协调、四肢僵硬，并伴有言语不流畅、吐词不清。 EMG示双侧腓总神经复合肌肉动作电位波幅偏低，运动神经传导速度（ MCV）正常；双侧胫神经、尺神经、正中神经MCV正常。双侧尺神经、左侧正中神经、左侧腓肠神经感觉神经传导速度（ SCV）正常。体感诱发电位（ SEP）示左上肢及左下肢深感觉通路未见异常；右上肢深感觉通路皮质段受损；右下肢深感觉通路受损。头颅MRI显示T1 WI矢状位及冠状位小脑的各直接径线均缩短；中脑线及延髓线之比值减少，脑干各径线与第四脑室前后径之比显著缩小；T2 WI可见脑桥“十字征”。结论 OPCA早期表现不典型，主要症状为双下肢无力及进行性的小脑性共济失调，伴有自主神经功能障碍。头颅MRI特点为“十字征”。
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