Millard-Gubler Syndrome in a Patient with Preeclampsia. Case Report and Review of Combined Intra- and Extra-Axial Facial and Abducens Nerve Injuries.

Millard-Gubler syndrome is a pontine syndrome caused by a lesion in the lower pons region. It is characterised by ipsilateral facial paralysis and VI paresis and contralateral brachiocrural palsy. We present the case of a female patient, G4P2A1, at 21 weeks of gestation, with preeclampsia, complaints of blurred vision, diplopia, and right hemiparesis, in whom a clinical diagnosis of Millard-Gubler syndrome was made. Neuroimaging showed an intraparenchymal haemorrhage towards the central portion of the bulbopontine junction. An extensive aetiological study was carried out to determine the cause of the hypertensive disorder syndrome during pregnancy. The patient improved satisfactorily from the neurological deficit after delivery of an early stillbirth.

Harnessing Neuroplasticity: A Case Report on Physiotherapy Rehabilitation for Millard-Gubler Syndrome.

This case report glances at the physiotherapy management and motor recovery outcomes of a 47-year-old female who had a pontine infarction complicated by Millard-Gubler syndrome. Pontine infarction is a stroke that occurs in the pons region of the brainstem, resulting in impaired blood flow and subsequent tissue damage. Millard-Gubler syndrome, a rare form of pontine infarction, is distinguished by ipsilateral abducens (sixth cranial nerve) and facial (seventh cranial nerve) nerve palsy, which cause horizontal gaze palsy and facial weakness, respectively. Other common symptoms include contralateral hemiparesis or hemiplegia, dysarthria, and hypertonia. In this case, the patient had nystagmus, dysarthria, hypertonia, decreased consciousness, and limited mobility. Physiotherapy interventions were used in a multidisciplinary approach to address these deficits, with a focus on improving gaze stability, reducing hypertonia, facilitating bed mobility, and improving respiratory function. The outcomes were evaluated using standardised measures such as the Brunnstrom staging for motor recovery, the Modified Ashworth Scale for hypertonia, and the Functional Independence Measure for functional status. This case demonstrates the critical role of physiotherapy in improving motor recovery and functional outcomes.

Pontine Infarct Resulting in Millard-Gubler Syndrome: A Case Report.

Millard-Gubler syndrome is a crossed brainstem syndrome involving the facial nerve, abducens nerve, and the pyramidal tracts, typically resulting in ipsilateral facial weakness and contralateral hemiparesis. Here we report the case of a 76-year-old female with no pertinent past medical history who presented to the emergency department with acute left-sided facial droop and right upper extremity sensory loss. A pontine infarction was identified on imaging and she was managed medically with complete recovery. Pontine infarction can result in Millard-Gubler syndrome and present with facial weakness and subtle contralateral limb symptoms.

Wall-Eyed Monocular Internuclear Ophthalmoplegia (WEMINO) and Millard-Gubler Syndromes in a Patient with Isolated Pontine Infarction: Topographic, Oculomotor, and Radiological Analysis of Two Very Uncommon Conditions.

The syndromes of wall-eyed monocular internuclear ophthalmoplegia and Millard-Gubler are very rare clinical complexes commonly caused by pontine infarction, hemorrhage, or tumors that compromise the paramedian tegmentum, medial longitudinal fascicle, and the basis pontis. We present the case of a 58-year-old female with an isolated pontine infarction characterized by acute vertigo, sudden horizontal diplopia due to ipsilateral internuclear ophthalmoplegia with exotropia, facial palsy and contralateral hemiparesis. This report analyzes, theorizes, and emphasizes the correlation between these atypical neurological findings, the pontine anatomy, and magnetic resonance imaging; encouraging the clinician to make expeditious diagnoses using the bedside skills and a high-quality oculomotor clinical examination. The phenotype and simultaneity of both syndromes makes this case a didactic exercise for the topo-diagnosis based on the neurology of eye movements, the intrinsic physiology of the pons, and the pathways that emerge or project towards it.

Adolphe Gubler (1821-1879) or Parisian neurology outside La Salpêtrière in the age of Jean-Martin Charcot.

Adolphe Gubler (1821-1879) is a typical example of a 19th century hospital physician in Paris. Head of a medical unit at Beaujon hospital in 1855, he was nominated to the treatment and pharmacognosia Chair in 1868. He trained many students who became his disciples and remained very close to him. Gubler published prolifically in all areas of medicine. His most well-known work is clearly his contribution to the study of vascular accidents affecting the brain stem, which Auguste Millard worked on simultaneously; hence the eponymous Millard-Gubler syndrome, an example of crossed hemiplegia. Following a brief biography, we will present Gubler's main publications in the area of neurology: on migraine, neurological damage during acute rheumatic fever, aphasia, and the autonomic nervous system. Much of this work was carried out through student theses that Gubler directed. The fame of his contemporary Jean-Martin Charcot (1825-1893) eclipsed that of Gubler, even though the latter was well known and respected among Parisian professors. By tying together the diverse threads of his work, we hope to renew interest in this 19th century neurologist.

Vertebrobasilar artery dissection manifesting as Millard-Gubler syndrome in a young ischemic stroke patient: A case report.

BACKGROUND: Millard-Gubler syndrome (MGS) is caused by a lesion in the brainstem at the level of the facial nerve nucleus, and it is also a rare ventral pontine syndrome. Vertebrobasilar artery dissection (VAD) is an uncommon cause of ischemic stroke. To the best of our knowledge, this is the first case report on the coexistence of MGS and VAD in a young acute ischemic stroke patient. CASE SUMMARY: We herein describe an unusual case of young acute ischemic stroke patient, presenting with acute right peripheral facial palsy, right abducens palsy, and contralateral hemihypesthesia, manifesting as MGS. After receiving dual antiplatelet therapy with aspirin and clopidogrel, as well as rosuvastatin, the patient recovered significantly. The high-resolution magnetic resonance imaging (MRI) indicated a diagnosis of VAD. CONCLUSION: Our finding further demonstrated that high-resolution MRI is a useful technique to early detect underlying dissection in posterior circulation ischemic stroke.

Síndrome de Millard-Gubler secundario a angioma cavernoso: reporte de un caso / Millard-Gubler syndrome secondary to cavernous angioma: report of a case

RESUMEN El síndrome de Millard-Gubler es considerado un síndrome protuberancial debido a una lesión pontina inferior y caracterizado, desde el punto de vista clínico, por parálisis facial y del VI par, ipsilateral a la lesión y parálisis braquiocrural contralateral; frecuentemente es de causa vascular, menos frecuente de causa traumática o por efecto de masa secundario a un tumor. Se realiza reporte de un caso de un paciente de 45 años de edad que acude al servicio hospitalario de la Fundación Centro Colombiano y Enfermedades Neurológicas FIRE con cuadro clínico caracterizado en pérdida de la fuerza muscular en hemicuerpo izquierdo, y déficit motor de la hemicara derecha, disartria y deterioro del estado de consciencia. La TAC de cráneo simple al ingreso evidenció sangrado extenso del tallo cerebral. De acuerdo con los hallazgos clínicos se concluye que el paciente presentó un síndrome de Millard-Gubler.

SUMMARY The Millard Gubler syndrome is considered a protuberant syndrome due to a lower pontine lesion and characterized, from the clinical point of view, by facial paralysis and VI pares, ipsilateral to the lesion and contralateral brachiocrural palsy; frequently it is of vascular cause, less frequent of traumatic cause or by effect of mass secondary to a tumor. A case report is presented of a 45-year-old patient who attends the hospital service of the Fundación Centro Colombiano y Neurológicas FIRE with a clinical picture characterized by loss of muscle strength in the left side of the body, and motor deficit of the right side of the face, dysarthria and deterioration of the state of consciousness. The simple skull CT on admission showed extensive brainstem bleeding. According to the clinical findings, it is concluded that the patient presented a Millard Gubler syndrome.

Pure ipsilateral central facial palsy and contralateral hemiparesis secondary to ventro-medial medullary stroke.

Medullary infarcts are occasionally associated with facial palsy of the central type (C-FP). This finding can be explained by the course of the facial corticobulbar (F-CB) fibers. It is believed that fibers that project to the upper facial muscles decussate at the level of the facial nucleus, whereas those destined to the lower facial muscles decussate more caudally, at the level of the mid or upper medulla. It has been proposed that the lower F-CB fibers descend ventromedially near the corticospinal tract to the upper medulla where they cross midline and ascend dorsolaterally. Accordingly, ventromedial medullary infarcts are expected to result in contralateral facial and limb weakness. We report a patient with a medial medullary infarct restricted to the right pyramid and associated with ipsilateral C-FP and contralateral hemiparesis. The neurological findings are discussed in light of the hypothetical course of the F-CB fibers in the medulla.

Neurocysticercosis presenting as Millard Gubler syndrome.

Neurocysticercosis is a common childhood neurological illness in India. A variety of presentations have been reported in the literature, including weber syndrome. Neurocysticercosis, manifesting as Millard Gubler syndrome, have not been reported in literature. Therefore, we report a child presented to us with Millard Gubler syndrome due to pontomedullary neurocysticercosis and was treated successfully.