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Millard–Gubler Syndrome
Millard–Gubler syndrome is a lesion of the pons. It is also called ventral pontine syndrome. Presentation Symptoms result from the functional loss of several anatomical structures of the pons, including the sixth and seventh cranial nerves and fibers of the corticospinal tract. Paralysis of the abducens nerve, 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 of facial expression and loss of the corneal reflex. Disruption of the corticospinal tract leads to hemiplegia, contralateral hemiplegia of the extremities. Diagnosis This syndrome is easier to diagnose today thanks to the technical advances in brain imaging (CT, MRI). It can also be identified based on the symptoms described above. Management Antiplatelets Eponym Millard–Gubler syndrome is named after two French physicians, Augus ...
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Pons
The pons (from Latin , "bridge") is part of the brainstem that in humans and other bipeds lies inferior to the midbrain, superior to the medulla oblongata and anterior to the cerebellum. The pons is also called the pons Varolii ("bridge of Varolius"), after the Italian anatomist and surgeon Costanzo Varolio (1543–75). This region of the brainstem includes neural pathways and tracts that conduct signals from the brain down to the cerebellum and medulla, and tracts that carry the sensory signals up into the thalamus.Saladin Kenneth S.(2007) Anatomy & physiology the unity of form and function. Dubuque, IA: McGraw-Hill Structure The pons is in the brainstem situated between the midbrain and the medulla oblongata, and in front of the cerebellum. A separating groove between the pons and the medulla is the inferior pontine sulcus. The superior pontine sulcus separates the pons from the midbrain. The pons can be broadly divided into two parts: the basilar part of the pons (ventral ...
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Pons
The pons (from Latin , "bridge") is part of the brainstem that in humans and other bipeds lies inferior to the midbrain, superior to the medulla oblongata and anterior to the cerebellum. The pons is also called the pons Varolii ("bridge of Varolius"), after the Italian anatomist and surgeon Costanzo Varolio (1543–75). This region of the brainstem includes neural pathways and tracts that conduct signals from the brain down to the cerebellum and medulla, and tracts that carry the sensory signals up into the thalamus.Saladin Kenneth S.(2007) Anatomy & physiology the unity of form and function. Dubuque, IA: McGraw-Hill Structure The pons is in the brainstem situated between the midbrain and the medulla oblongata, and in front of the cerebellum. A separating groove between the pons and the medulla is the inferior pontine sulcus. The superior pontine sulcus separates the pons from the midbrain. The pons can be broadly divided into two parts: the basilar part of the pons (ventral ...
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Cranial Nerves
Cranial nerves are the nerves that emerge directly from the brain (including the brainstem), of which there are conventionally considered twelve pairs. Cranial nerves relay information between the brain and parts of the body, primarily to and from regions of the head and neck, including the special senses of vision, taste, smell, and hearing. The cranial nerves emerge from the central nervous system above the level of the first vertebra of the vertebral column. Each cranial nerve is paired and is present on both sides. There are conventionally twelve pairs of cranial nerves, which are described with Roman numerals I–XII. Some considered there to be thirteen pairs of cranial nerves, including cranial nerve zero. The numbering of the cranial nerves is based on the order in which they emerge from the brain and brainstem, from front to back. The terminal nerves (0), olfactory nerves (I) and optic nerves (II) emerge from the cerebrum, and the remaining ten pairs arise from the ...
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Corticospinal Tract
The corticospinal tract is a white matter motor pathway starting at the cerebral cortex that terminates on lower motor neurons and interneurons in the spinal cord, controlling movements of the limbs and trunk. There are more than one million neurons in the corticospinal tract, and they become myelinated usually in the first two years of life. The corticospinal tract is one of the pyramidal tracts, the other being the corticobulbar tract. Anatomy The corticospinal tract originates in several parts of the brain, including not just the motor areas, but also the primary somatosensory cortex and premotor areas. Most of the neurons originate in the primary motor cortex (precentral gyrus, Brodmann area 4) or the premotor frontal areas.Purves, D. et al. (2012). Neuroscience: Fifth edition. Sunderland, MA: Sinauer Associates, Inc.Kolb, B. & Whishaw, I. Q. (2014). An introduction to brain and behavior: Fourth edition. New York, NY: Worth Publishers. About 30% of corticospinal neurons origi ...
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Paralysis
Paralysis (also known as plegia) is a loss of motor function in one or more muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory damage. In the United States, roughly 1 in 50 people have been diagnosed with some form of permanent or transient paralysis. The word "paralysis" derives from the Greek παράλυσις, meaning "disabling of the nerves" from παρά (''para'') meaning "beside, by" and λύσις (''lysis'') meaning "making loose". A paralysis accompanied by involuntary tremors is usually called "palsy". Causes Paralysis is most often caused by damage in the nervous system, especially the spinal cord. Other major causes are stroke, trauma with nerve injury, poliomyelitis, cerebral palsy, peripheral neuropathy, Parkinson's disease, ALS, botulism, spina bifida, multiple sclerosis, and Guillain–Barré syndrome. Temporary paralysis occurs during REM sleep, and dysregulation of this system can lead ...
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Abducens Nerve
The abducens nerve or abducent nerve, also known as the sixth cranial nerve, cranial nerve VI, or simply CN VI, is a cranial nerve in humans and various other animals that controls the movement of the lateral rectus muscle, one of the extraocular muscles responsible for outward gaze. It is a somatic efferent nerve. Structure Nucleus The abducens nucleus is located in the pons, on the floor of the fourth ventricle, at the level of the facial colliculus. Axons from the facial nerve loop around the abducens nucleus, creating a slight bulge (the facial colliculus) that is visible on the dorsal surface of the floor of the fourth ventricle. The abducens nucleus is close to the midline, like the other motor nuclei that control eye movements (the oculomotor and trochlear nuclei). Motor axons leaving the abducens nucleus run ventrally and caudally through the pons. They pass lateral to the corticospinal tract (which runs longitudinally through the pons at this level) before exiting t ...
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Esotropia
Esotropia is a form of strabismus in which one or both eyes turns inward. The condition can be constantly present, or occur intermittently, and can give the affected individual a "cross-eyed" appearance. It is the opposite of exotropia and usually involves more severe axis deviation than esophoria. Esotropia is sometimes erroneously called "lazy eye", which describes the condition of amblyopia; a reduction in vision of one or both eyes that is not the result of any pathology of the eye and cannot be resolved by the use of corrective lenses. Amblyopia can, however, arise as a result of esotropia occurring in childhood: In order to relieve symptoms of diplopia or double vision, the child's brain will ignore or "suppress" the image from the esotropic eye, which when allowed to continue untreated will lead to the development of amblyopia. Treatment options for esotropia include glasses to correct refractive errors (see accommodative esotropia below), the use of prisms and/or orthopti ...
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Facial Nerve
The facial nerve, also known as the seventh cranial nerve, cranial nerve VII, or simply CN VII, is a cranial nerve that emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue. The nerve typically travels from the pons through the facial canal in the temporal bone and exits the skull at the stylomastoid foramen. It arises from the brainstem from an area posterior to the cranial nerve VI (abducens nerve) and anterior to cranial nerve VIII (vestibulocochlear nerve). The facial nerve also supplies preganglionic parasympathetic fibers to several head and neck ganglia. The facial and intermediate nerves can be collectively referred to as the nervus intermediofacialis. The path of the facial nerve can be divided into six segments: # intracranial (cisternal) segment # meatal (canalicular) segment (within the internal auditory canal) # labyrinthine segment ...
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Corneal Reflex
The corneal reflex, also known as the blink reflex or eyelid reflex, is an involuntary blinking of the eyelids elicited by stimulation of the cornea (such as by touching or by a foreign body), though it could result from any peripheral stimulus. Stimulation should elicit both a direct and consensual response (response of the opposite eye). The reflex occurs at a rapid rate of 0.1 seconds. The purpose of this reflex is to protect the eyes from foreign bodies and bright lights (the latter known as the optical reflex). The blink reflex also occurs when sounds greater than 40–60 dB are made. The reflex is mediated by: * the nasociliary branch of the ophthalmic branch (V1) of the trigeminal nerve (CN V) sensing the stimulus on the cornea only (afferent fiber). * the temporal and zygomatic branches of the facial nerve (CN VII) initiating the motor response (efferent fiber). * the center (nucleus) is located in the pons of the brainstem. Use of contact lenses may diminish or ab ...
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Hemiplegia
Hemiparesis, or unilateral paresis, is weakness of one entire side of the body ('' hemi-'' means "half"). Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke.Detailed article about hemiparesis
at Disabled-World.com


Signs and symptoms

Depending on the type of hemiparesis diagnosed, different bodily functions can be affected. Some effects are expected (e.g., partial paralysis of a limb on the affected side). Other impairments, though, can at first seem completely non-related to the limb weakness but are, in fact, a direct result of the damage to the affected side of the brain.


Loss of m ...
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Auguste Louis Jules Millard
Auguste Louis Jules Millard (30 April 1830 in Paris – 13 November 1915 in Paris) was a French physician. He studied medicine in Paris, where in 1860 he attained the title of ''médecin des hôpitaux''. He subsequently worked at the Hôpital des Enfants-Malades, Hôpital Saint-Antoine and the Hôpital Lariboisière. From 1877 until 1895, he was associated with the Hôpital Beaujon in Paris. In 1854 he became a member of the ''Société anatomique de Paris'' (honorary member from 1866). In 1855 he identified a disorder characterized by unilateral softening of the brain caused by obstruction of the blood vessels of the pons. The condition was to become known as "Millard–Gubler syndrome", named in conjunction with Adolphe-Marie Gubler, who described the syndrome in a paper published in 1856. Selected writings * ''De la trachéotomie dans le cas de croup'' (1858, dissertation thesis) – On tracheotomy involving a case of croup. * ''Rapport sur un cas d'anévrysme de l'aor ...
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Adolphe-Marie Gubler
Adolphe-Marie Gubler (5 April 1821 – 20 April 1879) was a French physician and pharmacologist born in Metz. Originally a student of botany, he began his medical studies in 1841 at Paris, where he was a pupil of Armand Trousseau (1801–1867). In 1845 he became an ''interne des hôpitaux'', earning his doctorate in 1849. Afterwards he worked as a physician at the Hôpital Beaujon, and in 1853 earned his agrégation with a thesis on cirrhosis of the liver. In 1868 he was appointed professor of therapy to the medical faculty in Paris, maintaining this position until his death in 1879. Gubler made a number of contributions in the fields of medicine and pharmacology. He is credited with being the first physician to differentiate between hematogenous and hepatogenous icterus. His name is associated with "Millard–Gubler syndrome", a condition characterized by softening of brain tissue that is caused by blockage of blood vessels of the pons. The disease is named in conjunction with ...
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