Presentation

Symptoms result from the functional loss of several anatomical structures of the pons

Pons

The pons is a structure located on the brain stem, named after the Latin word for "bridge" or the 16th-century Italian anatomist and surgeon Costanzo Varolio . It is superior to the medulla oblongata, inferior to the midbrain, and ventral to the cerebellum. In humans and other bipeds this means it...

, including the sixth and seventh cranial nerves

Cranial nerves

Cranial nerves are nerves that emerge directly from the brain, in contrast to spinal nerves, which emerge from segments of the spinal cord. In humans, there are traditionally twelve pairs of cranial nerves...

 and fibers of the corticospinal tract

Corticospinal tract

The corticospinal or pyramidal tract is a collection of axons that travel between the cerebral cortex of the brain and the spinal cord....

. Paralysis

Paralysis

Paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...

 of the abducens (CN VI) leads to diplopia, internal strabismus, and loss of power to rotate the affected eye outward), and disruption of the facial nerve

Facial nerve

The facial nerve is the seventh of twelve paired cranial nerves. It emerges from the brainstem between the pons and the medulla, and controls the muscles of facial expression, and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue and oral cavity...

s (CN VII) leads to symptoms including flaccid paralysis of the muscles of facial expression and loss of the corneal reflex. Disruption of the corticospinal tract

Corticospinal tract

The corticospinal or pyramidal tract is a collection of axons that travel between the cerebral cortex of the brain and the spinal cord....

 leads to contralateral hemiplegia

Hemiplegia

Hemiplegia /he.mə.pliː.dʒiə/ is total paralysis of the arm, leg, and trunk on the same side of the body. Hemiplegia is more severe than hemiparesis, wherein one half of the body has less marked weakness....

 of the extremities.

It is a form of "crossed hemiplegia," as the paralysis of muscles controlled by the facial nerve occurs on the same side as the lesion, while the hemiplagia of muscles below the neck occurs on the opposite side as the lesion.

Diagnosis

This syndrome is easier to diagnose today thanks to the technical advances in brain imaging (CT, MRI).

Eponym

Millard-Gubler syndrome is named after two French physicians, Auguste Louis Jules Millard (1830-1915), who first identified the disorder in 1855, and Adolphe-Marie Gubler

Adolphe-Marie Gubler

Adolphe-Marie Gubler was a French physician and pharmacologist who was born in Metz.Originally a student of botany, he began his medical studies in 1841 at Paris, where he was a pupil of Armand Trousseau . In 1845 he became an interne des hôpitaux, earning his doctorate in 1849...

(1821-1879), who described the disease in a medical paper one year later.

External links