Pure ipsilateral central facial palsy and contralateral hemiparesis secondary to ventro-medial medullary stroke

Ahdab, Rechdi; Saade, Hiba; Kikano, Raghid; Ferzli, J.; Tarcha, W; Riachi, Naji

doi:10.1016/j.jns.2013.06.028

Cited by 8 publications

(9 citation statements)

References 8 publications

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“…Clinical features include ipsilateral peripheral facial palsy, ipsilateral abducens paralysis, contralateral hemidysesthesia, and central hemiplegia caused by the lesion of the ventrolateral pons. To date, there are only five case reports of MGS due to cerebral infarction[1,7-10] (Table 1). One case was a 56-year-old male who presented with left lower facial paralysis and hemiparesthesia on the right side, and brain MRI revealed an acute infarct in the left ventral pons[1].…”

Section: Discussionmentioning

confidence: 99%

“…Another case was a 63-year-old man who presented with left hemiparesis and right facial paralysis involving the lower facial muscles and the orbicularis oculi but sparing the frontalis muscle. DWI indicated acute infarction in ventro-medial aspect of the medulla[7].…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that MGS could be found in patients with brainstem tumor such as cavernous angioma[2-4], rimary meningeal hemangiopericytoma[5], neurocysticercosis[6]. As far as we know, only five cases of MGS caused by cerebral infarction have been reported[1,7-10]. Vertebrobasilar artery dissection (VAD) is an uncommon cause of ischemic stroke, especially in posterior circulation ischemic stroke[11].…”

Section: Introductionmentioning

confidence: 99%

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Vertebrobasilar artery dissection manifesting as Millard-Gubler syndrome in a young ischemic stroke patient: A case report

Li¹,

Yuan²,

Hu³

2019

WJCC

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BACKGROUNDMillard-Gubler syndrome (MGS) is caused by a lesion in the brainstem at the level of the facial nerve nucleus, and it is also a rare ventral pontine syndrome. Vertebrobasilar artery dissection (VAD) is an uncommon cause of ischemic stroke. To the best of our knowledge, this is the first case report on the coexistence of MGS and VAD in a young acute ischemic stroke patient.CASE SUMMARYWe herein describe an unusual case of young acute ischemic stroke patient, presenting with acute right peripheral facial palsy, right abducens palsy, and contralateral hemihypesthesia, manifesting as MGS. After receiving dual antiplatelet therapy with aspirin and clopidogrel, as well as rosuvastatin, the patient recovered significantly. The high-resolution magnetic resonance imaging (MRI) indicated a diagnosis of VAD.CONCLUSIONOur finding further demonstrated that high-resolution MRI is a useful technique to early detect underlying dissection in posterior circulation ischemic stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Vertebrobasilar artery dissection manifesting as Millard-Gubler syndrome in a young ischemic stroke patient: A case report

Li¹,

Yuan²,

Hu³

2019

WJCC

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“…[22][23][24] Only a few cases of MGS secondary to cerebral infarction have been described in the literature. [25][26][27][28] As far as we know, the coexistence of MGS and VBD has not been reported yet.…”

Section: Discussionmentioning

confidence: 99%

Vertebrobasilar artery dolichoectasia manifesting as Millard-Gubler syndrome in a young acute ischemic stroke

Hamid¹,

Adraoui²,

Mouloudi³

et al. 2022

JNSK

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Introduction: Vertebrobasilar dolichoectasia (VBD) is an arterial disease characterized by dilatation, elongation, and tortuosity of the vertebral and basilar arteries. VBD can generate intracranial hemorrhage, compression of the brainstem, and ischemic stroke as the most common presentation. Millard-Gubler syndrome (MGS) is a pontine-crossed syndrome affecting the pons at the level of the facial nerve nucleus. We present an unusual case of posterior circulation ischemic stroke presenting as MGS due to VBD. Observation: A 50-year-old man, with a medical history of high blood pressure, was hospitalized after 20 hours of transient dizziness, left facial numbness, and diplopia. On examination, he had a right hemiparesis with right Babinski. Deep tendon reflexes were present. Cranial nerves examination showed left abducens paresis with left peripheral facial nerve palsy. Cranial computed tomography (CT) imaging showed left pontine infarct with dilated basilar artery. Brain MRI showed a tortuous and dilated vertebrobasilar system touching the left acoustico-facial complex nerves with a high signal intensity involving the left anterolateral pons with a small right cerebellar hemorrhage. Paraclinical tests showed high blood total cholesterol and bilateral carotid artery atherosclerosis without stenosis. The patient received aspirin, atorvastatin with anti-hypertensive agents. Two weeks after his admission, there was a resolution of the left abducens nerve paresis with mild residual left peripheral facial paresis and left hemiparesis. Discussion: VBD is a complex arteriopathy with unknown etiology. Clinical symptoms in patients with VBD are various including brainstem and cranial nerve compression, intracranial hemorrhage, and ischemic stroke. MGS is an uncommon pontine-crossed syndrome occurring due to a lesion in the pons at the level of the facial nerve nucleus. MGS can be caused by brainstem tumor, cavernous angioma, neurocysticercosis, and cerebral infarction. The coexistence of MGS and VBD is rarer. Conclusion: Our case provides evidence that VBD may be presented as MGS secondary to a posterior circulation ischemic stroke. Therapeutic management of patients with VBD requires a careful balancing of the benefits and risks.

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“…At the level of the pons, Foville syndrome was frequently caused by hemorrhage (n = 8/15), followed by ischemic stroke (n = 4/15) and brain metastases (n = 2/15) [25][26][27][28][29][30][31][32][33][34][35][36][37]. Conversely, Millard-Gubler syndrome was mostly related to an ischemic stroke (n = 7/ 9), and rarely brought about by hemorrhage (n = 1/9) or brain abscess (n = 1/9) [38][39][40][41][42][43][44][45][46]. At the level of the medulla oblongata, Wallenberg syndrome was predominantly caused by ischemic stroke (n = 23/28), more rarely by hemorrhage (n = 2/28) or multiple sclerosis (n = 1/28) [18,.…”

Section: Causes Of Crossed Brainstem Syndromesmentioning

confidence: 99%

Crossed brainstem syndrome revealing bleeding brainstem cavernous malformation: an illustrative case

Beucler

Boissonneau

Ruf³

et al. 2021

BMC Neurol

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Background Since the nineteenth century, a great variety of crossed brainstem syndromes (CBS) have been described in the medical literature. A CBS typically combines ipsilateral cranial nerves deficits to contralateral long tracts involvement such as hemiparesis or hemianesthesia. Classical CBS seem in fact not to be so clear-cut entities with up to 20% of patients showing different or unnamed combinations of crossed symptoms. In terms of etiologies, acute brainstem infarction predominates but CBS secondary to hemorrhage, neoplasm, abscess, and demyelination have been described. The aim of this study was to assess the proportion of CBS caused by a bleeding episode arising from a brainstem cavernous malformation (BCM) reported in the literature. Case presentation We present the case of a typical Foville syndrome in a 65-year-old man that was caused by a pontine BCM with extralesional bleeding. Following the first bleeding episode, a conservative management was decided but the patient had eventually to be operated on soon after the second bleeding event. Discussion A literature review was conducted focusing on the five most common CBS (Benedikt, Weber, Foville, Millard-Gubler, Wallenberg) on Medline database from inception to 2020. According to the literature, hemorrhagic BCM account for approximately 7 % of CBS. Microsurgical excision may be indicated after the second bleeding episode but needs to be carefully weighted up against the risks of the surgical procedure and openly discussed with the patient. Conclusions In the setting of a CBS, neuroimaging work-up may not infrequently reveal a BCM requiring complex multidisciplinary team management including neurosurgical advice.

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Pure ipsilateral central facial palsy and contralateral hemiparesis secondary to ventro-medial medullary stroke

Cited by 8 publications

References 8 publications

Vertebrobasilar artery dissection manifesting as Millard-Gubler syndrome in a young ischemic stroke patient: A case report

Vertebrobasilar artery dissection manifesting as Millard-Gubler syndrome in a young ischemic stroke patient: A case report

Vertebrobasilar artery dolichoectasia manifesting as Millard-Gubler syndrome in a young acute ischemic stroke

Crossed brainstem syndrome revealing bleeding brainstem cavernous malformation: an illustrative case

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