Millard–Gubler syndrome is a lesion of the

pons The pons (from Latin , "bridge") is part of the brainstem that in humans and other mammals, 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 ...

. It is also called ventral pontine syndrome.Anatomy 530a at UWO (Functional Neuroanatomy)
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Presentation

Symptoms result from the functional loss of several anatomical structures of the

, including the sixth and seventh

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 f ...

and fibers of the

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 neu ...

Paralysis Paralysis (: paralyses; also known as plegia) is a loss of Motor skill, motor function in one or more Skeletal muscle, muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory d ...

of the abducens (CN VI) leads to diplopia, internal strabismus (i.e.,

esotropia Esotropia () is a form of strabismus in which one or both eyes turn 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 us ...

), and loss of power to rotate the affected eye outward), and disruption of the

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 ta ...

s (CN VII) leads to symptoms including flaccid paralysis of the muscles of facial expression and loss of the

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 ...

. Disruption of the

leads to 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, Auguste Louis Jules Millard (1830–1915), who first identified the disorder in 1855, and Adolphe-Marie Gubler (1821–1879), who described the disease in a medical paper one year later.

References

External links