Traumatic Millard-Gubler syndrome: Case report

Abstract

Introduction: Millard-Gubler syndrome is caused by a lesion in the ventral and caudal area of the pons, with a clinical manifestation of an alternating brainstem syndrome, characterized by paralysis of the sixth and seventh cranial nerves on the side of the lesion and contralateral hemiplegia. There are few reported cases of traumatic etiology.

Case presentation: A 22-year-old male patient presented to the Emergency Department with moderate head trauma due to a traffic accident, accompanied by a brief loss of consciousness. Upon evaluation, the patient exhibited an inability to abduct the right eye, right peripheral facial paralysis, and contralateral hemiparesis. Magnetic resonance imaging revealed a hyperintense lesion in T2 and FLAIR sequences located in the right ventral region of the pons, confirming the diagnosis of Millard-Gubler syndrome. Supportive measures and steroid administration were initiated, reducing muscle weakness in the limb and face, although ocular motor paralysis persisted during the acute phase.

Discussion: Alternating brainstem syndromes pose a diagnostic challenge in daily practice. Common causes include stroke, brainstem tumors, vascular malformations, and demyelination, with few reports on traumatic etiology and its clinical evolution.

Conclusions: Millard-Gubler syndrome secondary to trauma is a poorly known and studied condition due to its low incidence; furthermore, there is no definitively proposed pathophysiological mechanism that allows delimiting the appropriate treatment in these patients.