Ventral Pontine Syndrome (Millard-Gubler Syndrome)

Eponym

Millard-Gubler Syndrome

Anatomy

Pons: Basis pontis and fascicles of CN VI amd VII

Vascular

  • Basilar artery: Short circumferential branches
  • Basilar artery: Paramedian branches

Signs & Symptoms

Side Manifestation Comments
Contralateral Weakness – upper and lower extremity Pyramidal tract
Ipsilateral Lateral gaze weakness CN VI
Ipsilateral Weakness – face – entire side CN VII

Notes

A unilateral lesion of the ventrocaudal pons may invovle the basis pontis and the fascicles of cranial nerves VI and VII. Symptoms include:

  1. Contralateral hemiplegia (sparing the face) due to pyramidal tract involvement
  2. Ipsilateral lateral rectus palsy with diplopia that is accentuated when the patient looks toward the lesion, due to cranial nerve VI involvement.
  3. Ipsilateral peripheral facial paresis, due to cranial nerve VII involvement.