Millard-Gubler syndrome is a brainstem syndrome resulting from damage to the caudal parts of the pons. The most common cause of this phenomenon is stroke. The crossed symptoms of paralysis are characteristic of brainstem syndromes and are counteracted primarily with physiotherapy.
What is Millard-Gubler Syndrome?
The human brainstem consists of the parts of the brain below the diencephalon. Excluding the cerebellum, these are the midbrain and hindbrain including the associated structures of the cerebral peduncle, midbrain hood, midbrain roof, pons and spinal cord extension. See AbbreviationFinder for abbreviations related to Millard-Gubler Syndrome.
Damage to the structures involved in the brainstem is associated with functional impairments in motor functions and is also referred to as brainstem syndrome. Depending on the exact location of the damage, different brainstem syndromes are distinguished, the common feature of which is a crossed paralysis symptoms. One of the midbrain syndromes is Millard-Gubler syndrome.
This disease is named after its first describers, the French doctors Millard and Gubler. The first description dates from the 19th century. Due to the location of the damage and the symptoms, Millard-Gubler syndrome is also known in the specialist literature as caudal bridge foot syndrome or abduzens-facialis syndrome. Raymond-Foville syndrome is also sometimes mentioned.
Causes
Like all brainstem syndromes, Millard-Gubler syndrome is due to damage to the brainstem region. This damage usually occurs as part of a stroke. In Millard-Gubler syndrome, the primary cause is usually a stroke within the vertebral artery.
In the caudal sections of the bridge (pons), the nucleus nervi facialis, the core area of the facial nerves, is damaged during this event. The abducens nerve emerges in the immediate vicinity of this region, which is also affected by the ischemic stroke processes. In addition, the pyramidal tracts are affected by the damage.
Although stroke is considered the most common cause of Millard-Gubler syndrome, other disease events can also be considered as primary causes. Tumors in the caudal bridge region are just as conceivable as bacterial or autoimmune inflammation. Significantly less frequently, mechanical damage after accidents is responsible for the clinical picture.
Symptoms, Ailments & Signs
Like all brainstem syndromes, Millard-Gubler syndrome is characterized by crossed symptoms of paralysis. Crossing in this context means the inclusion of both sides of the body. In principle, the left side of the brain controls the right side of the body and vice versa. However, this only applies from the pyramidal tract crossing near the spinal cord.
For example, the facial nerves emerge on the same side of the body where they connect to the brain. In the case of crossed paralysis symptoms, both the facial nerves on the side of the brain damage and the nerves emanating from the spinal cord on the opposite side of the brain damage are affected. For this reason, in Millard-Gubler syndrome, facial paralysis and paralysis of the abductor occur on the side of the injury.
On the opposite side, there is a spastic hemiplegia due to the involvement of the pyramidal tract. In this context, spastic means that the muscles on the paralyzed side show increased tone and, for this reason, the limbs can only be moved to a limited extent or not at all.
Diagnosis & disease progression
The doctor makes the diagnosis of Millard-Gubler syndrome based on the clinical symptoms. In order to secure the suspected diagnosis, he orders an imaging procedure such as an MRI of the head. In the caudal bridging region of the brainstem, the primary causative brain damage is shown in the tomograms. The MRI can also be used for detailed diagnostics.
For example, tumors show a particularly characteristic image in the tomographic image, which differs significantly from inflammatory and ischemia -related brain damage. In case of doubt, an additional liquor analysis cannot be carried out. A sample of the cerebrospinal fluid is taken from the outer liquor space and sent to the laboratory.
Bacterial, autoimmune and tumor-related disease processes within the brain often change the composition of the cerebrospinal fluid in specific ways. The prognosis for patients with Millard-Gubler syndrome depends on the extent of the damage and the treatability of the primary cause of the damage.
Complications
Millard-Gubler syndrome causes paralysis on the patient’s body, which can occur in different places. Especially in the face, the paralysis and sensory disturbances can be very uncomfortable and lead to significant limitations in the patient’s life. It is not uncommon for those affected to be dependent on the help of other people in their everyday life and can no longer carry out certain activities on their own.
The intake of food and liquids can also be restricted here, so that the Millard-Gubler syndrome leads to a severe reduction in the patient’s quality of life. Movement restrictions also occur and those affected suffer from muscle weakness and exhaustion. The treatment of Millard-Gubler syndrome is usually causal and is geared primarily to the underlying disease that is responsible for these symptoms.
If it is a tumor, it may have spread to other parts of the body. Furthermore, those affected are usually dependent on physiotherapy. It is generally not possible to generally predict whether there will be a reduction in life expectancy.
When should you go to the doctor?
Since Millard-Gubler syndrome is a congenital disease and self-healing cannot occur, a doctor must be consulted with this complaint in any case. Without treatment, the symptoms of Millard-Gubler syndrome can make a person’s life significantly more difficult. A doctor should usually be consulted if the patient suffers from paralysis that can occur in different parts of the body. Often, one entire side of the patient’s body is paralyzed, preventing them from moving that side.
Millard-Gubler syndrome can also lead to spastic disorders, so that the limbs can only be moved to a very limited extent. If these symptoms occur, a doctor should always be consulted. An MRI scan of the head is usually necessary to diagnose and identify Millard-Gubler syndrome, so this disease cannot be diagnosed by a general practitioner. The life expectancy of the patient is usually not negatively affected by the disease, but it can only be treated to a limited extent.
Treatment & Therapy
Therapy for patients with Millard-Gubler syndrome depends on the primary cause. In the case of acute inflammation, conservative drug treatment is used. Autoimmune inflammation is counteracted with cortisone.
In addition, patients with autoimmune diseases such as multiple sclerosis receive long-term therapy with immunosuppressants, which weaken the immune system and thus dampen future inflammation. Bacterial inflammations in the context of Millard-Gubler syndrome are in turn cured with antibiotics as soon as the type of causative pathogen has been determined.
If tumors have caused the symptoms, an operation for excision takes place as far as possible. Depending on the degree of malignancy, concomitant drug therapy or radiotherapy may be required. Inoperable tumors are also treated using these measures. If a stroke caused the syndrome, stroke prevention is done immediately to reduce the risk of future ischemia.
Irrespective of the cause, symptomatic treatment takes place in Millard-Gubler syndrome in addition to the therapy steps mentioned. Since the brain is home to highly specialized tissue, the ability of brain tissue to regenerate is severely limited. This means that damage to the brain tissue is irreparable.
However, the redistribution of brain functions from defective areas to healthy areas in the vicinity could be observed, especially in stroke patients. To support this redistribution, patients with Millard-Gubler syndrome receive physiotherapy and, if necessary, speech therapy, as well as targeted access to the functions of the damaged areas together with specialists. The brain can thus be moved to redistribute.
Outlook & Forecast
Those affected suffer from various mental and physical ailments as a result of the disease. The quality of life is therefore significantly reduced. Those affected are permanently dependent on the help and support of relatives. Simple activities can no longer be carried out independently. For this reason, severe depression and other mental illnesses often occur.
The movement and coordination of those affected is also impaired. Speech disorders, paralysis and sensitivity disorders can occur. Affected people often suffer from dizziness. Tongue paralysis can also occur. Those affected can then no longer independently take in food or liquids. Artificial nutrition may be necessary to prevent the body from becoming undersupplied. As a result of the illness and the suffering of the person concerned, relatives can also suffer from severe depression and other mental illnesses.
It is not possible to say whether the course of the disease will be positive after treatment. It is therefore possible that those affected spend their whole lives with the symptoms and have to deal with them. The life expectancy of those affected is usually only reduced if the tumor cannot be removed. In other cases, the disease has no effect on the life expectancy of those affected.
Prevention
In the context of Millard-Gubler syndrome, preventive measures are limited to stroke prevention. In addition to concentrating on healthy nutrition and sufficient exercise, risk factors such as tobacco consumption are minimized as far as possible in the context of stroke prevention.
Aftercare
Millard-Gubler syndrome can lead to serious complications or discomfort for those affected and must therefore be treated by a doctor in any case. It is also not possible for the patient to heal on his own, so that the patient is always dependent on treatment by a doctor. In most cases, this syndrome leads to severe paralysis of the affected person.
The paralysis can affect different parts of the body and have a very negative effect on the quality of life of those affected. This leads to significant limitations in the everyday life of those affected, so that most patients are dependent on the help and support of friends or their own family. It is not uncommon for the Millard-Gubler syndrome to lead to severe depression or other mental upsets in the family.
There is severe paralysis in the muscles, so that the patients can no longer move independently. The paralysis often only occurs on one side of the body. In some cases, the disease can also lead to mental problems, so that those affected by Millard-Gubler syndrome sometimes suffer from reduced intelligence.
You can do that yourself
The measures that those affected can take themselves depend on the cause and severity of the disease. Acute inflammation is usually treated with medication, supported by bed rest and rest. Drugs are also the best choice for autoimmune inflammation.
The most important self-help measure is to document the effects of the drugs and thus to achieve an optimal setting of the respective drug. In case of serious complications, the doctor should be informed. If Millard-Gubler syndrome occurs as a result of a tumor disease, an operation is necessary. Those affected can best support the procedure by following the diet suggested by the doctor before the operation. A balanced diet supports the immune system and contributes to the healing process. Rest is also important after an operation. Radiation therapy is also best survived by not putting any strain on the body.
Accompanying these measures, symptomatic treatment is required. Neurological damage can be corrected by physiotherapy and, if necessary, speech therapy. Therapeutic advice is particularly useful when Millard-Gubler syndrome has caused severe brain damage that has a lasting impact on the patient’s quality of life and well-being.
