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Millard-Gubler Syndrome

Facial Abducens Hemiplegia Syndrome

Millard-Gubler syndrome is a rare lesion of the brainstem affecting the abducens (VI) and the facial (VII) cranial nerves, as well as the pyramidal tract. 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.


Presentation

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].

Overeating
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  • Includes over 2,700 high-quality images, 1,000 of which appear for the first time in this edition.[books.google.com]
  • Includes 2,600 illustrations , images and artworks, with over 900 brand new for this edition, including ultra wide-field imaging, fundus autofluorescence, and high-resolution OCT. Consult this title on your favourite e-reader.[books.google.com]
  • Q (LQ 2012) Vesicular lesions over ext. auditory meatus & pharynx.[gradestack.com]
Regurgitation
  • There was no history of fever, headache, seizures, altered sensorium, diplopia, nasal regurgitation of feeds, trauma, ear discharge, rash, recent vaccination, and history of contact with an open or treated case of tuberculosis.[ruralneuropractice.com]
Diplopia
  • 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]
  • Käännettävä sana (suomeksi tai englanniksi): X Hakuluettelo: Käännös: Millard-Gubler syndrome Määritelmät: (lb, en, medicine) A lesion of the pons, leading to diplopia, strabismus, and contralateral hemiplegia of the extremity, extremities.[suomienglantisanakirja.fi]
  • 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]
  • Paralysis of the abducens (CN VI) leads to diplopia, internal strabismus, 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 of facial expression[mnemonics-usmle.blogspot.com]
  • […] paralysis syndromes , which are characterised 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]
Retinal Cyst
  • On fundus examination, there was no retinal cyst and evidence of papilloedema. She was oriented and hemodynamically stable. Rest of the systemic examination was unremarkable.[ruralneuropractice.com]

Workup

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

  • You'll confidently identify the signs and symptoms of disease, know when additional diagnostic testing is indicated, accurately interpret diagnostic data, and recommend effective treatment options.[books.google.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.[ruralneuropractice.com]
  • Experience of the optic neuritis treatment trial. Neurology 1997:49:1404-1413. ‎[books.google.com]
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  • Clinical Eye exam: Vertical and horizontal nystagmus; Right V, VI, VII, VIII nerve palsy; gaze palsy Pathology Pontine abscess Disease/Diagnosis Millard-Gublar Syndrome Treatment Surgery Relation is Part of Case presented at the NANOS 1973 Walsh Session[collections.lib.utah.edu]

Prognosis

  • The prognosis for central pain syndromes is poor with no spontaneous resolution of symptoms.[academic.oup.com]
  • Prognosis 6DAFTAR PUSTAKAMardjono M. Sidharta P. 2013. Neurologi Klinis Dasar, Ed IX. Dian Rakyat. Jakarta.Kesikburun S, Ismail S, Ridvan A. Pontine Cavernoma Hemorrhage Leading to Millard-Gubler Syndrome.[docslide.net]
  • Wittmaack-Ekbom's syndrome; RLS Overview Historical Perspective Classification Pathophysiology Causes Differentiating Restless legs syndrome from other Diseases Epidemiology and Demographics Risk Factors Screening Natural History, Complications and Prognosis[wikidoc.org]
  • Prognosis dari berbagai sindrom tersebut sangat tergantung dari penyebab yang mendasari gangguan tersebut sehingga dalam penatalaksanaanya juga didasarkan pada gangguan atau lesi primer yang menyebabkan fungsi sebagian atau beberapa saraf kranial tersebut[lovedoc.org]
  • Prognosis This will depend on the extent of disease; however: Acute basilar artery occlusion has a very high mortality rate. Vertebrobasilar stroke usually leaves significant neurological deficits.[patient.info]

Etiology

  • Scarce reports exist regarding its etiology, but vascular insults, tumors, and infectious diseases (neurocysticercosis and tuberculosis) have been described.[symptoma.com]
  • Its etiology and the mechanism are discussed here. We tend to conclude that, in addition to direct damage, its mechanism can be attributed to vasostenosis of the perforators from the basilar artery compressed by the prepontine subarachnoid hematoma.[unboundmedicine.com]
  • It shows the main etiologic cerebral infarcts are not always well explored. Indi aspects.[books.google.com]
  • Etiology and pathogeny of a syndrome of Miyyara-Gyubler . Defeat in area of the bridge of a brain, especially as a result of hemorrhages and softenings. See also Syndrome of pyramidal ways of the central department. Differential diagnosis . S.[infomeds.info]

Epidemiology

  • , 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]
  • ., Wegener, HC, and Tauxe, RV Epidemiology of Campylobacter jejuni infections in the United States and other industrialized nations.[books.google.es]
  • ; 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 syndrome from other Diseases Epidemiology[wikidoc.org]
Sex distribution
Age distribution

Pathophysiology

  • […] 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]
  • ., 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 syndrome from other[wikidoc.org]
  • Pathophysiology Atherosclerosis : the most common vascular disease affecting the vertebrobasilar system: [ 1 ] This affects large vessels, causing narrowing and occlusion.[patient.info]
  • Pathophysiology (Ref. Hari. 18 th ed., Pg- 3362) In acute Bell's palsy there is inflammation of the facial nerve with mononuclear cells, consistent with an infectious or immune cause.[gradestack.com]

Prevention

  • Collaborative Meta-Analysis of Randomised Trials of Antiplatelet Therapy for Prevention of Death, Myocardial Infarction, and Stroke in High Risk Patients. ‎[books.google.es]
  • 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 of the[wikidoc.org]
  • Even with vertebral artery occlusion, collaterals (circle of Willis) may prevent ischaemia.[patient.info]
  • Prevention of recurrent stroke Strict risk factor control is important to decrease the risk of stroke recurrence. [41] Prevention strategies depend on the primary cause of the stroke.[emedicine.medscape.com]
  • This is in addition to preventing complications that could arise from immobility, swallowing difficulties and other cranial neuropathies.[academic.oup.com]

References

Article

  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.

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Last updated: 2018-06-21 23:27