Millard-Gubler Syndrome is a rare neurological condition caused by damage to the sixth and seventh cranial nerves, as well as the corticospinal tract in the brainstem. It is characterized by the presence of ipsilateral facial paralysis and contralateral hemiplegia. We report a 55-year-old male patient who presented with sudden onset of left-sided weakness. Imaging revealed a pontine infarct. The patient therefore, was diagnosed with Millard-Gubler Syndrome also known as Ventral Pontine Syndrome based on his symptoms and imaging findings. He was treated with Aspirin and Atorvastatin and was referred to neurology for further consultation and to physiotherapy for his weakness. This case report highlights the importance of prompt recognition and diagnosis of Millard-Gubler Syndrome in patients with pontine infarction. Early identification especially with the use of high-resolution MRI can facilitate appropriate management and treatment, ultimately improving patient outcomes.
References
[1]
Beucler, N., Boissonneau, S., Ruf, A., Fuentes, S., Carron, R. and Dufour, H. (2021) Crossed Brainstem Syndrome Revealing Bleeding Brainstem Cavernous Malformation: An Illustrative Case. BMC Neurology, 21, Article No. 204. https://doi.org/10.1186/s12883-021-02223-7
[2]
Querol-Pascual, M.R. (2010) Clinical Approach to Brainstem Lesions. Seminars in Ultrasound, CT and MRI, 31, 220-229. https://doi.org/10.1053/j.sult.2010.03.004
Walusinski, O. (2019) Adolphe Gubler (1821-1879) or Parisian Neurology outside La Salpêtrière in the Age of Jean-Martin Charcot. Revue Neurologique (Paris), 175, 207-216. https://doi.org/10.1016/j.neurol.2018.07.010
[5]
Ayele, B.A., Tadesse, Y., Guta, B. and Zenebe, G. (2021) Millard-Gubler Syndrome Associated with Cerebellar Ataxia in a Patient with Isolated Paramedian Pontine Infarction—A Rarely Observed Combination with a Benign Prognosis: A Case Report. CRN, 13, 239-245. https://doi.org/10.1159/000515330
[6]
Sakuru, R., Elnahry, A.G. and Bollu, P.C. (2022) Millard Gubler Syndrome. StatPearls Publishing, Treasure Island. https://www.ncbi.nlm.nih.gov/books/NBK532907/
[7]
Abdallah, A., Asitürk, M., Abdallah, B.G. and Emel, E. (2015) Millard-Gubler Syndrome: A Case Report. Journal of Nervous System Surgery, 5, 10-104. https://doi.org/10.5222/sscd.2015.101
[8]
Kumral, E., Bayülkem, G. and Evyapan, D. (2002) Clinical Spectrum of Pontine Infarction. Clinical-MRI Correlations. Journal of Neurology, 249, 1659-1670. https://doi.org/10.1007/s00415-002-0879-x
[9]
Ahmad, H., Bukhari, M.H. and Asghar, M. (2019) Infarction of Ventral Pons Presenting as Millard-Gubler Syndrome: A Case Report. Journal of Rawalpindi Medical College, 23, 128-129. https://www.journalrmc.com/index.php/JRMC/article/view/1278
[10]
Evans, M.R.B. and Weeks, R.A. (2016) Putting Pontine Anatomy into Clinical Practice: The 16 Syndrome. Practical Neurology, 16, 484-487. https://doi.org/10.1136/practneurol-2016-001367
[11]
Field, T.S. and Benavente, O.R. (2011) Penetrating Artery Territory Pontine Infarction. Reviews in Neurological Diseases, 8, 30-38.