[A rare case of delayed traumatic Millard-Gubler syndrome]

We reported a rare case of traumatic Millard-Gubler syndrome exhibiting right peripheral facial palsy and right abducens palsy plus left hemiparesis. A 60-year-old male patient was admitted to our department due to tetraparesis. He fell down and struck his neck and shoulder. Several hours later he was aware of muscle weakness in all extremities. On admission neurological examination revealed right peripheral facial palsy, right abducens palsy and left hemiparesis suggesting Millard-Gubler syndrome. CT demonstrated a high density mass in the prepontine cistern. MRI showed an iso intensity mass compressing the right ventral surface of the pons at T1 weighted and low intensity at T2 weighted image. The presence of a subarachnoid hematoma in acute stage was suggested. This is the third case report of traumatic Millard-Gubler syndrome in literature. Its etiology and the mechanism are discussed here. We tend to conclude that, in addition to direct damage, its mechanism can be attributed to vasostenosis of the perforators from the basilar artery compressed by the prepontine subarachnoid hematoma.