Vertebrobasilar artery dissection manifesting as Millard-Gubler syndrome in a young ischemic stroke patient: A case report

Abstract

BACKGROUNDMillard-Gubler syndrome (MGS) is caused by a lesion in the brainstem at the level of the facial nerve nucleus, and it is also a rare ventral pontine syndrome. Vertebrobasilar artery dissection (VAD) is an uncommon cause of ischemic stroke. To the best of our knowledge, this is the first case report on the coexistence of MGS and VAD in a young acute ischemic stroke patient.CASE SUMMARYWe herein describe an unusual case of young acute ischemic stroke patient, presenting with acute right peripheral facial palsy, right abducens palsy, and contralateral hemihypesthesia, manifesting as MGS. After receiving dual antiplatelet therapy with aspirin and clopidogrel, as well as rosuvastatin, the patient recovered significantly. The high-resolution magnetic resonance imaging (MRI) indicated a diagnosis of VAD.CONCLUSIONOur finding further demonstrated that high-resolution MRI is a useful technique to early detect underlying dissection in posterior circulation ischemic stroke.

Pontine Infarct Resulting in Millard-Gubler Syndrome: A Case Report

“…Our patient had a full recovery within one week of presentation. This is consistent with the clinical course described in case reports, especially those involving small acute infarcts [2,4,6,7,9,10].…”

“…Millard-Gubler syndrome, also known as ventral pontine syndrome or facial abducens hemiplegia syndrome, was first described in 1858, and was classically associated with a pontine mass [8]. Subsequent reports, however, have involved cases caused by bleeding and infarcts, and rarely neurocysticercosis [2][3][4][5][6][7]9,10]. The lesion lies above the level of the decussation of the pyramidal and spinothalamic tracts.…”

“…Millard-Gubler syndrome is a rare ventral pontine syndrome that manifests with ipsilateral weakness of the eye upon abduction (abducens nerve), ipsilateral facial muscle weakness (facial nerve), and contralateral hemiparesis or hemiplegia of the upper and lower extremities (pyramidal tract fibers) [1][2][3]. This is usually due to unilateral lesion at the basal portion of the caudal pons as a result of a mass, hemorrhage, or rarely, infarction [4][5][6][7]. Hemorrhage and infarction are more common in older patients, while tumors and infections are more common in younger individuals.…”

Strabismus and oculoplastic surgery in a case with Millard-Gubler Syndrome

“…Genç yaşlarda, tümörler, enfeksiyöz ve demyelinizan hastalıklar daha sık görülürken; daha ileri yaşlarda hemoraji, iskemi, travma sonrası prepontin subaraknoid hematoma bağlı arter basısı gibi vasküler patolojiler daha ön plandadır (1). Literatürde günümüze kadar, 7 yaşında bir kız çocuğunda pontomedüller sistiserkoza bağlı enfeksiyöz (4), serebral infarkta bağlı iskemik (5,6), kavernöz hemanjioma bağlı hemorajik (7), serebellopontin köşede hemanjioperisitoma ve kavernöz sinüs menenjiomuna bağlı tümöral (8) ve travmatik. Görüntüleme yöntemleriyle iskemik dört vakada vertebrobaziler sistemde oklüzyon saptanırken, iki vakada iskeminin sebebi net olarak ortaya konamamıştır.…”

Crossed brainstem syndrome revealing bleeding brainstem cavernous malformation: an illustrative case

“…At the level of the pons, Foville syndrome was frequently caused by hemorrhage (n = 8/15), followed by ischemic stroke (n = 4/15) and brain metastases (n = 2/15) [25][26][27][28][29][30][31][32][33][34][35][36][37]. Conversely, Millard-Gubler syndrome was mostly related to an ischemic stroke (n = 7/ 9), and rarely brought about by hemorrhage (n = 1/9) or brain abscess (n = 1/9) [38][39][40][41][42][43][44][45][46]. At the level of the medulla oblongata, Wallenberg syndrome was predominantly caused by ischemic stroke (n = 23/28), more rarely by hemorrhage (n = 2/28) or multiple sclerosis (n = 1/28) [18,.…”