Three cases of Pontine Ischemic Syndrome Analysis (Millard-Gubler)

Abstract

Background: Millard-Gubler syndrome is characterized by crossed paralysis affecting the members on one side of the body and the face on the opposite side. It results from the lesion of the medioinferior (base) region of the pons, compromising the corticospinal tract and the facial nerve fibers. This disorder can also be associated with abducens nerve palsy. The finding of this syndrome in patients with a diagnosis of Ischemic Stroke is uncommon. Objectives and Methods: Report the syndrome in 03 patients diagnosed with ischemic stroke in the territory of branches of the basilar artery due to involvement of the circumferential pontine artery that irrigates the tegumentary territory of the VI and VII nerves. Results: The patients presented with facial weakness with deviation of the labial commissure, with convergent strabismus of the eye bulb on the same side, in addition to contralateral motor deficit. A computed tomography revealed a hypodense lesion located anterior to the pons, suggesting ischemic stroke. In the evolution of the cases, one patient developed coma, with brainstem infarction due to thrombosis of the basilar artery, while the other 2 cases evolved without sequelae. The risk factors that led to this event will be discussed and compared. Conclusions: These cases reports have their importance justified by the unusual presentation of this pons stroke, and it reinforces the fundamental role of neurological semiology, assessment of risk factors and image, for correct early diagnostic suspicion and treatment.