Ayele Biniyam A, Tadesse Yonas, Guta Betesaida, Zenebe Guta
Department of Neurology, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Radiology, School of Medicine, St. Paul Millennium Medical College, Addis Ababa, Ethiopia.
Case Rep Neurol. 2021 Apr 13;13(1):239-245. doi: 10.1159/000515330. eCollection 2021 Jan-Apr.
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.
孤立性脑桥梗死占所有缺血性卒中的7%。Millard-Gubler综合征是一种临床综合征，发生于累及脑桥尾端腹侧的病变之后，导致典型的临床特征，如同侧展神经和面神经麻痹以及对侧偏瘫。我们报告一例55岁男性患者，6年前因突发构音障碍和持续10天的肢体共济失调就诊于Yehuleshet专科诊所。他自述有右侧半身无力和视力模糊，此后已显著改善。他有30包年的吸烟史。然而，他8年前戒烟了。既往无卒中、短暂性脑缺血发作、糖尿病、高血压、头部外伤或血脂异常病史。检查时，他有向左水平凝视麻痹伴水平眼球震颤，提示左侧第6颅神经麻痹。他有轻度左侧面神经麻痹导致构音障碍。检查时观察到右侧上肢辨距不良；否则，运动、感觉、眼底和步态检查结果均正常。他血清维生素D水平低。脑部磁共振成像检查显示左侧脑桥中部有一个25×10mm的节段性病变，累及脑桥基底部和被盖部。病变T2和T1异常延长，无弥散受限，提示亚急性脑桥梗死。该患者接受了325mg阿司匹林、80mg阿托伐他汀治疗，进行了物理治疗并补充了维生素D，并就行为危险因素给予了建议。孤立性脑桥梗死6年后，患者构音障碍、面神经麻痹、偏瘫、右侧肢体共济失调和水平眼球震颤已完全恢复，随访脑部MRI显示有慢性脑桥旁正中穿支梗死的影像学证据。如果脑桥旁正中梗死区域稍向外扩展，影响小脑中脚，Millard-Gubler综合征可能会出现小脑共济失调。孤立性脑桥梗死如果早期诊断和治疗，预后可能良好。
