Millard-Gubler syndrome, initially described more than 150 years ago, is a lesion of the brainstem that develops in the ventral pons, and the term "ventral pontine syndrome" is often used as a synonym [1] [2] [3]. More specifically, it belongs to a group of "crossed paralysis syndrome", as it is responsible for causing facial lesions on one side and limb deficits on the other [1] [2]. Scarce reports exist regarding its etiology, but vascular insults, tumors, and infectious diseases (neurocysticercosis and tuberculosis) have been described [1] [3] [4] [5]. The clinical presentation is distinguished by unilateral palsy of the cranial nerves VI and VII (abducens and facial nerves, respectively), together with contralateral hemiparesis, as the corticospinal tract is affected before its decussation [4] [5] [6]. Hence, weakness of the lateral rectus muscle will lead to diplopia and medial deviation of the affected eye, whereas lesions of the facial nerve (responsible for innervating the muscles of facial expression, including the platysma, orbicularis oculi, mentalis, orbicularis oris, and several other), will present with deviation of the mouth angle and a variable degree of facial paralysis [1] [2] [5]. Millard-Gubler syndrome is distinguished from other similar brainstem disorders by the absence of sensory deficits, as both the medial lemniscus and the spinothalamic tracts are not damaged [1].

• Diplopia

  Paralysis of the abducens (CN VI) leads to diplopia, internal st... Found on http://en.wikipedia.org/wiki/Millard–Gubler_syndrome Millard-Gubler syndrome Synonym for Gubler's syndrome ... [encyclo.co.uk]

  Clinical presentation ipsilateral facial and contralateral body hemiplegia due to pyramidal tract involvement isotropism and diplopia that is worsened while the patient looks toward the lesion ipsilateral facial paresis and loss of corneal reflex Pathology [pacs.de]

  […] crossed paralysis syndromes, which are characterized by cranial nerves VI and VII palsies with contralateral body motor or sensory disturbances 1-3. ipsilateral facial and contralateral body hemiplegia due to pyramidal tract involvement 1-3 isotropism and diplopia [radiopaedia.org]

  Paralysis of the abducens (CN VI) leads to diplopia, internal strabismus (i.e., esotropia), and loss of power to rotate the affected eye outward), and disruption of the facial nerves (CN VII) leads to symptoms including flaccid paralysis of the muscles [en.wikipedia.org]

  Thus the diplopia is horizontal and worse in the distance. [howlingpixel.com]

• Long Tract Signs

  Therefore, the clinical signs of the cranial nerve are ipsilateral to the lesion, and the long tract signs contralateral, resulting in crossed syndrome. [ncbi.nlm.nih.gov]

• Cranial Nerve Involvement

  […] or Bilateral CN III Nothnagel Syndrome Tracts Superior Cerebellar Peduncle Ocular Palsey, Occular paralysis of gaze and cerebellar ataxia Nothnagel syndrome Causes Parinaud Syndrome Cranial Nerves Involved Parinaud Syndrome Tracts Involved Supranuclear [quizlet.com]

  Cranial nerves examination revealed right abducens paresis with right peripheral facial nerve palsy with no other cranial nerve involvement. Examination of other extra neurological systems was unremarkable. [medcraveonline.com]

The diagnosis of Millard-Gubler syndrome rests on the ability of the physician to recognize this rare brainstem syndrome, which can be done only by performing a detailed physical examination. Lesions of both abducens and facial nerve, as well as hemiplegia, must be confirmed by a properly conducted neurological exam. Because of the fact that different etiologies might induce Millard-Gubler syndrome, a complete patient history should be taken as well, in order to identify whether additional symptoms could possibly point toward an infection (fever, for example) or a vascular insult (presence of additional neurological deficits). Regardless, the use of imaging studies should be advised, and computed tomography (CT), but more commonly magnetic resonance imaging (MRI), are effective methods for visualizing the ventral aspect of the pons [1] [4] [5]. More importantly, the associated lesions (tuberculomas, tumors, or cysticercus granulomas) can be readily identified using these methods [3] [5].

• Dyslipidemia

  The most common risk factors in previous series of small vessel pontine infarcts have been hypertension, diabetes, and dyslipidemia [10]. [karger.com]

Conclusion : More accurate diagnosis, more aggressive treatments and further researches are all required on this disease afterwards. [koreascience.or.kr]

Given the lack of evidence-based clinical guidelines for the management of ischemic stroke caused by VBD, the treatment of patients with VBD remains a challenge. [medcraveonline.com]

Efficacy of treatment should be monitored by repeat CT/MRI after 3 months.[7] Our patient improved and became asymptomatic with steroid treatment and albendazole. [cyberleninka.org]

The information in this site is provided only as a resource for PG entrance aspirants, and is not to be used for any diagnostic or treatment purposes. [pgblazer.com]

Treatment / Management Treatment mainly depends on the etiology of the disease. In some cases, patients presenting with multiple deficits require early conservative measures together with multidisciplinary rehabilitation. [ncbi.nlm.nih.gov]

Differential Diagnosis Ataxic hemiparesis Dysarthria Locked-in syndrome Pure motor hemiparesis Raymond syndrome Ventral pontine syndromes Prognosis Prognosis mainly depends on the extent and etiology of the disease. [ncbi.nlm.nih.gov]

Etiology Causes of Millard-Gubler syndrome (MGS) vary with age. [ncbi.nlm.nih.gov]

in patients who have one major plus two minor criteria, in those who have one major plus one minor and one epidemiologic criterion, and in those who have three minor plus one epidemiologic criterion. [scienceopen.com]

Epidemiology Epidemiology varies according to the cause of the disease. Pathophysiology This syndrome is caused due to a lesion at ventral part of the pons that involves the fibers of cranial nerves VI, VII, and corticospinal tract fibers. [ncbi.nlm.nih.gov]

[…] signification worked out study than one exclusively devoted to a of imaging and magnetic resonance imaging, which limited number of scientific papers. will perhaps allow us to detect ischemic edema in the After a brief clinical and pathophysiological [books.google.com]

Sections Continuing Education Activity Introduction Etiology Epidemiology Pathophysiology History and Physical Evaluation Treatment / Management Differential Diagnosis Prognosis Pearls and Other Issues Enhancing Healthcare Team Outcomes Review Questions [pubmed.ncbi.nlm.nih.gov]

Pathophysiology This syndrome is caused due to a lesion at ventral part of the pons that involves the fibers of cranial nerves VI, VII, and corticospinal tract fibers. [ncbi.nlm.nih.gov]

Currently, he is on secondary stroke preventive therapy as well as physical and behavioral therapy. Illustration Fig. 3. [Image omitted. [proquest.com]

Currently, he is on secondary stroke preventive therapy as well as physical and behavioral therapy. [karger.com]

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1. Matlis A, Kleinman Y, Korn-Lubetzki I. Millard-Gubler syndrome. AJNR Am J Neuroradiol. 1994;15(1):179-181.
2. Kesikburun S, Safaz I, Alaca R. Pontine cavernoma hemorrhage leading to Millard-Gubler syndrome. Am J Phys Med Rehabil. 2011;90(3):263.
3. Prasad R, Kapoor K, Srivastava A, Mishra O. Neurocysticercosis presenting as Millard Gubler syndrome. J Neurosci Rural Pract. 2012;3(3):375-377.
4. Yasuda Y, Matsuda I, Sakagami T, Kobayashi H, Kameyama M. Pontine infarction with pure Millard-Gubler syndrome: precise localization with magnetic resonance imaging. Eur Neurol. 1993;33(4):331-334.
5. Sharif M, More V, Purandare S. Brainstem tuberculoma--presenting as Millard Gublar syndrome. Indian J Pediatr. 2010;77(6):707.
6. Azarmina M, Azarmina H. The Six Syndromes of the Sixth Cranial Nerve. J Ophthalmic Vis Res. 2013;8(2):160-171.