Isolated pontine infarction accounts for 7% of all ischemic strokes. Millard-Gubler syndrome is a clinical syndrome which occurs following lesions involving the ventral portion of the caudal pons, resulting in classic clinical features such as ipsilateral abducens and facial nerve palsy and contralateral hemiparesis. We report the case of a 55-year-old male patient having presented to the Yehuleshet Specialty Clinic 6 years back with sudden-onset dysarthria and appendicular ataxia of 10 days duration. He reported having right hemibody weakness and blurred vision, which have significantly improved since then. He had a history of smoking of 30 pack-years. However, he quit smoking 8 years ago. There was no history of prior stroke, transient ischemic attack, diabetes, hypertension, head trauma, or dyslipidemia. On examination, he had horizontal left gaze palsy with horizontal nystagmus suggesting left-sided 6th cranial nerve palsy. He had mild left-sided facial palsy causing dysarthric speech. Right upper limb dysmetria was observed during examination; otherwise, motor, sensory, fundus, and gait examination results were normal. He had low serum vitamin D. Brain magnetic resonance imaging examination showed a 25 × 10 mm segmental lesion in the left median pons involving the basis pontis and tegmentum section. The lesion had T2 and T1 abnormal prolongation with no diffusion restriction, suggesting a subacute pontine infarct. The patient was managed with aspirin 325 mg, atorvastatin 80 mg, physical therapy, and vitamin D supplementation, and advised on behavioral risk factors. Six years after his isolated pontine infarction, the patient is fully recovered from dysarthria, facial palsy, hemiparesis, right-sided appendicular ataxia, and horizontal nystagmus, and the follow-up brain MRI showed radiological evidence of chronic paramedian pontine perforator infarction. Millard-Gubler syndrome may present with cerebellar ataxia if the paramedian pontine infarction area slightly extends laterally, affecting the middle cerebellar peduncles. Isolated pontine infarction may have a good prognosis if diagnosed and managed early.

Background In 2050, it is estimated that the number of dementia patients in the sub Saharan Africa is expected to reach 5.05 million, an increase of 136% from the previous estimate of 2.14 million. The objectives of the present study were to assess the neuroimaging findings and associated factors in dementia suspected patients. Method A retrospective survey of the medical records of 121 suspected dementia patients whom presented to the Yehuleshet Specialty Clinic with subjective forgetfulness were reviewed. The study duration was between January 1, 2020 and December 31, 2021. Both descriptive and analytical statistics were used to analyze the data. Results The mean age was 70.4 (1SD = 10.3) years. Sixty four (52.9%) participants were age below 70. Male accounted for 57.9%. Hyperlipidemia was the commonest (38%) identified vascular risk factor followed by prevalence of hypertension (32.2%) and diabetes mellitus (22.3%). HIV infection was observed in 3.3%. Low mean serum vitamin D level (below 20ng/mL) was observed in individuals with focal & global cortical atrophy and those with white matter hyperintensity. Fifty two (43%) participants fulfilled the clinical and imaging criteria of vascular cognitive impairment (VCI). Nearly quarter of the patients had imaging evidences of focal or global cortical atrophy. Eleven (9.1%) had imaging evidences of surgical causes of dementia. the presences of comorbid hypertension, previous stroke, and Parkinsonism were independent predictors of vascular dementia. Conclusion The present study shows high burden of vascular cognitive impairment among individuals suspected of dementia. Furthermore, the presences of comorbid hypertension, previous stroke, and Parkinsonism were independent predictors of vascular dementia.