Question

A 62-year-old patient presents with left-sided arm and leg weakness, right-sided facial paralysis, and difficulty with horizontal eye movements. Based on the clinical presentation, which of the following syndromes is most consistent with these symptoms?

• A. Foville syndrome
• B. Benedict’s syndrome
• C. Millard-Gubler syndrome
• D. Wallenberg syndrome

Hint:

In patients with a combination of facial paralysis, hemiparesis, and eye movement difficulties, think of Millard-Gubler syndrome and consider a lesion in the pons.

Answer 1

The Correct Option is C

The clinical presentation of this patient involves left-sided arm and leg weakness, right-sided facial paralysis, and difficulty with horizontal eye movements. To determine the syndrome, we need to analyze these symptoms based on neurological pathways and their anatomical localization.

Analysis:

• Left-sided arm and leg weakness suggests a lesion on the right side of the brainstem or above, affecting the corticospinal tract.
• Right-sided facial paralysis indicates an involvement of the facial nerve or its nuclei on the right side.
• Difficulty with horizontal eye movements points towards a disruption in the pons, specifically affecting structures that control ocular motility, such as the abducens nerve.

Syndrome Assessment:

• Foville syndrome: Characterized by contralateral hemiplegia and ipsilateral palsy of cranial nerves causing facial paralysis, but more closely linked with ocular palsies not specific to the given case.
• Benedict’s syndrome: Not consistent as it involves midbrain lesions and is characterized by ipsilateral oculomotor nerve palsy with contralateral tremor.
• Millard-Gubler syndrome: This occurs due to a lesion in the pons affecting the corticospinal tract and facial nerve, leading to contralateral hemiparesis and ipsilateral facial paralysis. The difficulty with horizontal eye movements further implies pontine involvement.
• Wallenberg syndrome: Associated with lateral medullary infarction, not exhibiting the described combination of facial and limb motor symptoms.

Conclusion: The symptoms best align with Millard-Gubler syndrome, which accounts for both the motor and cranial nerve deficits described. This syndrome perfectly matches the presentation of left arm and leg weakness with right facial paralysis caused by lesions in the lateral pons.