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Space occupying lesion presenting as Millard-Gubler syndrome
Uddalak Chakraborty1, Arindam Santra1, Alak Pandit1
1Department of Neurology, Institute of Postgraduate Medical Education and Research, Bangur Institute of Neurology, Kolkata, West Bengal, India.
Abstract:
Millard-Gubler syndrome (MGS) is a ventral pontine syndrome due to an ipsilateral involvement of abducens and facial nerve with a contralateral hemiparesis or hemiplegia. Although classically described as a vascular brainstem syndrome, various other aetiologies such as infection or demyelination may lead to MGS. In this case, a young female presented with MGS, which was attributed to a strategically located infective granuloma of the brainstem. In countries, where tuberculosis is still considered an endemic, central nervous system involvement due to tuberculosis may have protean manifestations.
Insights
Millard-Gubler syndrome (MGS), a brainstem condition, can stem from infections, not just vascular issues. This case highlights a rare presentation of MGS caused by a brainstem granuloma, emphasizing tuberculosis as a potential cause.
Area of Science:
- Neuroscience
- Infectious Diseases
- Neurology
Background:
- Millard-Gubler syndrome (MGS) is a ventral pontine syndrome characterized by ipsilateral abducens and facial nerve palsy with contralateral hemiparesis.
- Traditionally attributed to vascular etiologies, MGS can also result from infections, demyelination, or tumors.
- Central nervous system tuberculosis (CNS TB) presents with diverse neurological manifestations.
Observation:
- A young female patient presented with clinical features consistent with Millard-Gubler syndrome.
- Neuroimaging revealed a strategically located infective granuloma within the brainstem.
- The patient's presentation was ultimately attributed to this brainstem granuloma.
Findings:
- The case demonstrates a rare, non-vascular cause of Millard-Gubler syndrome.
- An infective granuloma in the brainstem was identified as the etiology.
- This finding underscores the varied presentations of central nervous system tuberculosis.
Implications:
- Highlights the importance of considering infectious etiologies, particularly tuberculosis, in endemic regions for Millard-Gubler syndrome.
- Suggests that brainstem granulomas should be included in the differential diagnosis for MGS.
- Emphasizes the protean manifestations of CNS tuberculosis, necessitating broad diagnostic considerations.
