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The inferior medial pontine syndrome of Foville: clinical nuances reported since its first description
Source publication
Background
Since the nineteenth century, a great variety of crossed brainstem syndromes (CBS) have been described in the medical literature. A CBS typically combines ipsilateral cranial nerves deficits to contralateral long tracts involvement such as hemiparesis or hemianesthesia. Classical CBS seem in fact not to be so clear-cut entities with up t...
Context in source publication
Context 1
... we closely examine the clinical nuances reported throughout the history concerning Foville syndrome, the ipsilateral contralateral different forms of oculomotor palsies that were observed led to the distinction between a "superior Foville syndrome" characterized by the presence of a CN VI palsy and an "inferior Foville syndrome" with lateral conjugate gaze palsy due to the involvement of the medial longitudinal fasciculus or the paramedian pontine reticular formation (Table 3). ...Similar publications
BACKGROUND
While cases of trigeminal neuralgia induced by a brainstem infarct have been reported, the neurosurgical literature lacks clear treatment recommendations in this subpopulation.
OBSERVATIONS
The authors present the first case report of infarct-related trigeminal neuralgia treated with pontine descending tractotomy that resulted in durabl...
Citations
... 57 The specific symptoms linked to DBH identified in this review, including central dyspnea (probable damage to periaqueductal gray matter), bilateral motor deficit, internuclear ophthalmoplegia (probable damage to the medial longitudinal fasciculus), and palsies of CN IIIe VII, are all anatomically consistent with damage to the midbrain, the upper pons, or the middle pons. 62 ...
Context:
Historically, the occurrence of hemorrhage in the brainstem after an episode of supratentorial intracranial hypertension has been described by Henri Duret in 1878. Nevertheless, to date the eponym Duret brainstem hemorrhage (DBH) lacks systematic evidence regarding its epidemiology, pathophysiology, clinical and radiologic presentation, and outcome.
Materials and methods:
We conducted a systematic literature review and meta-analysis using Medline database from inception to 2022 looking for English-language articles concerning DBH, in accordance with the PRISMA guidelines.
Results:
The research yielded 28 articles for 32 patients (mean age 50 years, male/female 3/1). There were 41% of head trauma causing 63% of subdural hematoma, responsible for coma in 78% and mydriasis in 69%. DBH appeared on the emergency imaging in 41% and on delayed imaging in 56%. DBH was located in the midbrain in 41% of the cases, and in the upper of middle pons in 56%. DBH was caused by sudden downward displacement of the upper brainstem secondary to supratentorial intracranial hypertension (91%), intracranial hypotension (6%), or mechanical traction (3%). Such downward displacement caused the rupture of basilar artery perforators. Brainstem focal symptoms (p=0.003) and decompressive craniectomy (p=0.164) were potential favorable prognostic factors, whereas an age>50 years showed a trend toward a poor prognosis (p=0.0731).
Conclusion:
Unlike its historical description, DBH appears as a focal hematoma in the upper brainstem caused by the rupture of anteromedial basilar artery perforators after sudden downward displacement of the brainstem, regardless of its cause.
Keywords ► anatomy ► Collet-Sicard ► skull base ► skull base trauma ► skull base tumor ► systematic review Abstract Combined deficit of the four lower cranial nerves (CN IX, X, XI, and XII) was originally described by French physicians Collet (1915) and Sicard (1917) during World War I. To date though, this rare neurological clinical picture lacks systematic evidence regarding its epidemiology, clinical presentation, treatment strategies, and outcome. We conducted a systematic review and meta-analysis concerning Collet-Sicard syndrome (CSS) on Medline database in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The research yielded 84 articles among which 73 individual case reports were eventually retained. Mean age was 53.7 (AE 16) years old and the male-to-female ratio was 1.8/1. CSS was firstly caused by tumors (38.4%), following by vascular etiologies (28.8%), trauma (16.4%), and infection (6.8%), among others. Temporary enteral nutrition was required for 17 patients (23.3%). The four CN presented significant chances of complete or partial recovery: 52.1% for CN IX (p < 0.001), 46.6% for CN X and CN XII (p < 0.001), and 39.7% for CN XI (p ¼ 0.002). Tumoral causes presented significantly lower chances of favorable CN recovery (7.1%) compared to infection (60%), vascular (52.4%), and trauma (41.7%) (p < 0.001). Older age (> 53 years old) was not associated with a dismal CN prognostic (p ¼ 0.763). Most patients (71.2%) presented a favorable outcome (Glasgow Outcome Scale score ! 4). All the patients who died (6.8%) suffered from skull base tumors. CSS is a rare condition requiring prompt clinical and radiologic diagnostic and multidisciplinary management. Vascular or infectious-related CSS seem to present a rather good prognostic, closely followed by trauma, whereas tumoral-related CSS seem to suffer from a more dismal prognostic.
Millard-Gubler Syndrome is a rare neurological condition caused by damage to the sixth and seventh cranial nerves, as well as the corticospinal tract in the brainstem. It is characterized by the presence of ipsilateral facial paralysis and contralateral hemiplegia. We report a 55-year-old male patient who presented with sudden onset of left-sided weakness. Imaging revealed a pontine infarct. The patient therefore, was diagnosed with Millard-Gubler Syndrome also known as Ventral Pontine Syndrome based on his symptoms and imaging findings. He was treated with Aspirin and Atorvastatin and was referred to neurology for further consultation and to physiotherapy for his weakness. This case report highlights the importance of prompt recognition and diagnosis of Millard-Gubler Syndrome in patients with pontine infarction. Early identification especially with the use of high-resolution MRI can facilitate appropriate management and treatment, ultimately improving patient outcomes .
ResumenIntroducción. El síndrome de Foville (síndrome pontino dorsal inferior) es una entidad clínica que hace parte de una subclasificación de la categoría más amplia de eventos cerebrovasculares de la circulación posterior, se presenta como resultado de la oclusión de la arteria basilar debido a lesiones en el tegmento pontino. Este síndrome tiene una muy baja incidencia a nivel mundial, pero es de gran relevancia clínica. Presentación del caso. Hombre de 41 años sin antecedentes patológicos, que ingresó al servicio de urgencias por signos de focalización neurológica. Sus hallazgos imagenológicos fueron compatibles con una lesión isquémica en el tronco encefálico y la angiografía cerebral evidenció un compromiso en el territorio de la arteria basilar. El paciente fue diagnosticado y se le dio seguimiento en la unidad de cuidados intensivos (UCI) hasta su rehabilitación. Conclusión. El síndrome de Foville es una enfermedad infrecuente y de alta mortalidad. El reconocimiento temprano de esta afección y un abordaje multidisciplinario son determinantes para mejorar el pronóstico del paciente.
