Pontine Infarct Presenting in Millard-Gubler Syndrome: A Rare Case Report

Abstract

Millard-Gubler condition (MGS) is a rare neurological syndrome caused by a single lesion in the basis pontis (ventral pons). This neurological syndrome is characterized by an ipsilateral palsy of the facial nerve (CN VII) and a contralateral hemiparesis, which are caused by corticospinal tract involvement in the pons above the pyramids' medullary decussation. Here, we present the case of a 60-year-old female patient who was admitted to the emergency room with the complaint of left facial palsy and weakness on the right side of her body due to pontine infarct. She had a history of hypertension with irregular medication use. An acute infarct on the ventral aspect of the pons was discovered following a brain MR diffusion, and it was consistent with Millard-Gubler syndrome. She was treated with dual antiplatelet therapy and strict blood pressure control. Eventually, her condition significantly improved, and she was able to return to her prior functional state after consistent physical therapy. MGS is a rare brainstem condition characterized by a unilateral lesion to the basal area of the ventral pons, which affects the facial (VII) cranial nerve and corticospinal tract. This case emphasizes the importance of considering pontine infarction in the differential diagnosis of patients presenting with MGS. Timely diagnosis and treatment are crucial for optimal patient outcomes.