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].

• Weakness

  Unilateral palsy of these nerves accompanied by contralateral motor weakness of the limbs is the typical clinical presentation. The diagnosis is made on clinical grounds, and the underlying cause often requires a thorough imaging workup. [symptoma.com]

  MGS clinical features are an ipsilateral weakness of eye abduction and ipsilateral facial muscle weakness along with contralateral upper and lower extremity weakness. Diagnosis of MGS depends on a detailed history and physical examination. [ncbi.nlm.nih.gov]

• Fever

  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 [symptoma.com]

  Most read articles by the same author(s) Tamanna Fayyaz, Maria Yasin, Ahsan Tariq, Aashi Mughal, Mujtaba Haider Bukhari, Khushbakht Ms., Knowledge About Dengue Fever Prevention Among People Visiting Benazir Bhutto Hospital, Journal of Rawalpindi Medical [journalrmc.com]

  Because various etiologies might cause MGS, take a detailed history to exclude other causes like infection (fever) or vascular insult (presence of other neurologic deficits). [ncbi.nlm.nih.gov]

• Epilepsy

  A missense mutation in the neuronal nicotinic acetylcholine receptor alpha 4 subunit is associated with autosomal dominant nocturnal frontal lobe epilepsy. ‏ [books.google.com]

  Restless legs - Stiff person Other degenerative / demyelinating diseases Alzheimer's - Pick's - Alpers' - Dementia with Lewy bodies - Leigh's demyelinating: Multiple sclerosis - Devic's - Central pontine myelinolysis - Transverse myelitis Seizure / epilepsy [wikidoc.org]

  A missense mutation in the neuronal nicotinic acetylcholine receptor alpha 4 subunit is associated with autosomal dominant nocturnal frontal lobe epilepsy. ‎ [books.google.de]

  Leziunile iritative (epilepsie temporala) apar iluzii auditive, halucinatii auditive Tulburarile de echilibru – atacuri de vertij, uneori cu ataxie Tulburarile de gust si miros – halucinatii olfactive pot apare ca parte a crizelor epileptice. [slideplayer.com]

• Nausea

  Medial Medullary Syndrome Ipsilateral paralysis and tongue atrophy C/L arm and leg weakness C'L loss of Proprioception and touch sensation Medulla: Lateral Medullary Syndrome Ipsilateral pain and numbness to face Ipsilateral limb ataxia, hiccough Vertigo nausea [neurovascularmedicine.com]

  Clinical manifestations vary with the size of infarction, but may include loss of pain and temperature sensation in the ipsilateral face and contralateral body below the chin; ipsilateral horner syndrome; ipsilateral ataxia; dysarthria; vertigo; nausea [icd10data.com]

  Involvement of the vestibular system causes nausea, vomiting and vertigo. Ipsilateral features: Ataxia from cerebellar involvement. Horner's syndrome from damage to descending sympathetic fibres. [patient.info]

  History of present illness Two days before admission, the patient experienced sudden dizziness and nausea, followed by slurred speech, dysphagia, and choking. Before the onset of the illness, he did not suffer from fever or cervical pain. [wjgnet.com]

• Hiccup

  Dysphasia, dysarthria, vertigo, hiccups, nystagmus. [brainscape.com]

  Clinical manifestations vary with the size of infarction, but may include loss of pain and temperature sensation in the ipsilateral face and contralateral body below the chin; ipsilateral horner syndrome; ipsilateral ataxia; dysarthria; vertigo; nausea, hiccup [icd10data.com]

  […] temperature and pain sensation Hemiparesis 11 Lateral medullary syndrome (Wallenberg syndrome) This is the commonest of the brain stem strokes Vertebral artery or postero-inferior cerebellar artery Sudden onset Intense vertigo, vomit, balance problems, hiccup [slideplayer.com]

• Vascular Disease

  You are more likely to have vascular disease as you get older. [icdlist.com]

  Master the latest advances in ophthalmology: radical changes in the management of macular disease, including the widespread introduction of VEGF inhibitor therapy; recent developments in the investigation and treatment of retinal vascular disease; new [books.google.com]

  Página 249 - Omenn GS, Motulsky AG: A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. ‎ [books.google.es]

  This includes inflammatory disorders, neoplastic processes, hemorrhages, and vascular malformations such as arteriovenous malformations.[2] Treatment Vascular disease is the most common etiology of FS.[2] This can manifest as atheromatous branch occlusion [eyewiki.aao.org]

  Most frequently caused by vascular disease or tumors involving the dorsal pons.Inferior Medial Pontine Syndrome (Foville Syndrome ... ; Home » Professionals » Stroke Diagnosis » Stroke Syndromes » Inferior Medial Pontine Syndrome ... [xxmxraut.gq]

• Tinnitus

  […] cerebral peduncle and hemisphere main sensory nucleus and descending tract Impaired muscles of mastication Lateral Inferior Pontine Syndrome Signs Horizontal and vertical nystagmus Facial Paralysis Paralysis conjugate gaze to side of lesion Deafness Tinnitus [quizlet.com]

  Cerebellopontine angle neuroma Acoustic LMN type of I/L facial weakness tinnitus. Ophth div of V nerve also affected 4. [gradestack.com]

  Differential diagnosis Symptoms associated with vertebral artery occlusive disease include dizziness, vertigo, diplopia, perioral numbness, blurred vision, tinnitus, ataxia, bilateral sensory deficits, and syncope, all of which can be caused by other [patient.info]

  Case presentation A 65-year-old man presented with a 10-day history of sudden onset binocular diplopia and gait disturbance; he also complained of tinnitus. His medical history consisted in chronic glaucoma treated with latanoprost eye droplets. [bmcneurol.biomedcentral.com]

• Diplopia

  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]

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

  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, [symptoma.com]

  Definitions from Wiktionary, Creative Commons Attribution/Share-Alike License. noun medicine A lesion of the pons, leading to diplopia, strabismus, and contralateral hemiplegia of the extremities. Etymologies Sorry, no etymologies found. [wordnik.com]

  Symptoms include: Contralateral hemiplegia (sparing the face) due to pyramidal tract involvement Ipsilateral lateral rectus palsy with diplopia that is accentuated when the patient looks toward the lesion, due to cranial nerve VI involvement. [strokecenter.org]

• Esotropia

  Our exam revealed a large angle right esotropia, right gaze palsy with pronounced abduction deficit of the right eye, right peripheral facial nerve palsy, and end-gaze nystagmus on left gaze. [aaopt.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 [operativeneurosurgery.com]

  The inability of an eye to turn outward and results in a convergent strabismus or esotropia of which the primary symptom is diplopia (commonly known as double vision) in which the two images appear side-by-side. [howlingpixel.com]

  Ipsilateral lateral rectus palsy leading to diplopia that is accentuated when the patient looks towards the side of the lesion, internal strabismus (i.e., Esotropia) and loss of power to rotate the affected eye outward due to the involvement of CN VI. [ncbi.nlm.nih.gov]

• Stroke

  Medical complications after stroke: a multicenter study. [eyewiki.aao.org]

  Learning objectives Types of Brainstem strokes Introduction The brainstem is vulnerable to both ischaemic and haemorrhagic strokes. Out come is very variable depending if strokes are unilateral or bilateral. [neurovascularmedicine.com]

  Acute stroke care in the US: results from 4 pilot prototypes of the Paul Coverdell National Acute Stroke Registry. Stroke. 2005 Jun. 36(6):1232-40. [Medline]. [Full Text]. Dirnagl U, Pulsinelli W. [medscape.com]

  Ischemic stroke of pons on CT brain shows a hypodense lesion in the anteromedial side of the pons. [ncbi.nlm.nih.gov]

• Ataxia

  Claudes Syndrome Combination of features of benedicts and Nothnagel’s syndromes. 3rd N palsy with contralateral tremor and ataxia, no hemiparesis. [masterofmedicine.com]

  Midbrain: Paramedian Branches of PCA and Basilar Perforators (Ipsilateral) CN III Palsey (Contralateral) Weakness, vertical gaze palsey Midbrain: PCA occlusion - stroke of rednucleus and cerebral peduncle (Ipsilateral) CN III Palsey (Contralateral) Ataxia [quizlet.com]

  Our patient presented with right-sided hemiparesis, left upper limb ataxia, dysarthria, and left-sided facial and abducens palsy. [karger.com]

  MGS often presents with other neurological deficits such as contralateral hemiparesthesia and contralateral cerebellar ataxia as many other nuclei fibers exist near the root fibers of the facial nerve nucleus. [unboundmedicine.com]

  ( Friedreich's ataxia, Ataxia telangiectasia, Hereditary spastic paraplegia ) Spinal muscular atrophy : Werdnig-Hoffman - Kugelberg-Welander - Fazio Londe - MND ( ALS, PMA, PBP, PP, PLS ) Extrapyramidal and movement disorders Parkinson's disease - Neuroleptic [wikidoc.org]

• Dysarthria

  Our patient presented with right-sided hemiparesis, left upper limb ataxia, dysarthria, and left-sided facial and abducens palsy. [karger.com]

  […] 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 [scielo.org.co]

  In 2011 she developed right hemiparesis, dysarthria, ataxia and a left CN V, VII, and VIII palsy. MRI showed a left pontine cavernous hemangioma. The next 10 years involved worsening hemiparesis and spasticity consistent with MGS. [n.neurology.org]

  Dysphasia, dysarthria, vertigo, hiccups, nystagmus. [brainscape.com]

• Tremor

  Claudes Syndrome Combination of features of benedicts and Nothnagel’s syndromes. 3rd N palsy with contralateral tremor and ataxia, no hemiparesis. [masterofmedicine.com]

  Contralateral tremor. (Tremor is usually attributed to interruption of cerebellothalamic fibres but it may be continuous, from involvement of pallidothalamic fibres rostral to the red nucleus) 3. [prep4usmle.com]

  Midbrain: Paramedian Branches of PCA and Basilar Perforators (Ipsilateral) CN III Palsey (Contralateral) Weakness, vertical gaze palsey Midbrain: PCA occlusion - stroke of rednucleus and cerebral peduncle (Ipsilateral) CN III Palsey (Contralateral) Ataxia, Tremor [quizlet.com]

  Neuroleptic malignant syndrome - Postencephalitic parkinsonism - Pantothenate kinase-associated neurodegeneration - Progressive supranuclear palsy - Striatonigral degeneration Dystonia / Dyskinesia ( Spasmodic torticollis, Meige's, Blepharospasm ) Essential tremor [wikidoc.org]

• Vertigo

  At the time of the first visit, all the symptoms persisted except for the vertigo followed by continuous dizziness and unsteadiness when walking. [karger.com]

  Share to Facebook Subscribe Report this video by HUKA Official one year ago 3,228 a female patient, who was onset by the symptom of Vertigo beyond Right hemiparalysis. [hmongbuy.net]

  A female patient, who was onset by the symptom of Vertigo beyond Right hemiparalysis. She got seven nerve palsy with sixth nerve palsy, which caused her gaze not to see to the left. [umedico.com]

  Medulla: Medial Medullary Syndrome Ipsilateral paralysis and tongue atrophy C/L arm and leg weakness C'L loss of Proprioception and touch sensation Medulla: Lateral Medullary Syndrome Ipsilateral pain and numbness to face Ipsilateral limb ataxia, hiccough Vertigo [neurovascularmedicine.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].

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]

The book also provides updated epidemiologic and statistical data throughout and includes a section on biostatistics in physical medicine and rehabilitation. [books.google.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]

Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D. [2] Synonyms and Keywords: Wittmaack-Ekbom's syndrome; RLS Overview Historical Perspective Classification Pathophysiology Causes Differentiating Restless legs [wikidoc.org]

Download PDF; select article Myasthenia gravis: pathophysiology, diagnosis, differential diagnosis and management ... select article The Millard-Gubler syndrome. Short communication Full text access The Millard-Gubler syndrome. [wsqmyxwt.ga]

Collaborative Meta-Analysis of Randomised Trials of Antiplatelet Therapy for Prevention of Death, Myocardial Infarction, and Stroke in High Risk Patients. ‎ [books.google.es]

Most read articles by the same author(s) Tamanna Fayyaz, Maria Yasin, Ahsan Tariq, Aashi Mughal, Mujtaba Haider Bukhari, Khushbakht Ms., Knowledge About Dengue Fever Prevention Among People Visiting Benazir Bhutto Hospital, Journal of Rawalpindi Medical [journalrmc.com]

| Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies Case Studies Case #1 Actigraphy Parasomnia Disease mongering v t e Pathology of the nervous system, primarily CNS ( G00-G47, 320-349 ) Inflammatory diseases [wikidoc.org]

Even with vertebral artery occlusion, collaterals (circle of Willis) may prevent ischaemia. [patient.info]

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

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.