1978 Volume 9 Issue 2 Pages 113-116
A 59-year-old woman with long-standing hypertension and rheumatism suddenly suffered the left facial and abducens palsy as well as weakness and numbness of the right limbs. with ipsilateral exaggerated deep tendon reflexes and a feeble extensor plantar response. The left facial paresis disappeared in several days. The other symptoms also have receded gradually by now 8 months after the onset only remain a slight degree of diplopia on the left lateral gaze and of dysesthesia in the right arm and leg. Although no abnormal findings were noted in skull x-ray films, CSF, radionuclide brain scan or CT scan except for EEG which showed sporadic spikes in the centro-parietal region, the clinical course of this patient strongly suggests the pontine lesion to be of vascular, origin. Infarction with concomitant, edema caused by thrombosis of the paramedian artery was suspected from the unique combination of the symptoms and the mode of their disappearance. The classical eponymic syndrome of Millard-Gubler seldom occurs. Actually there have been only 10 case reports in Japan including the present case, in some of which the syndrome was mixed with other various symptoms or observed only transitionally on final massive lesions. Among these 10 cases, the cause of 3 was hemorrhage, 3 infarction, 2 trauma, 1 encephalitis and only 1 tumor, though it has been said that the syndrome results mostly from pontine tumor.