## Why Millard-Gubler syndrome is right Millard-Gubler syndrome results from ventral pontine infarction affecting the region marked **A** (anterior pons with corticospinal tracts). The classic triad is: (1) ipsilateral CN VI palsy (abducens — lateral rectus weakness), (2) ipsilateral CN VII palsy (facial weakness), and (3) contralateral hemiplegia (from corticospinal tract damage in the ventral pons). This is the pathognomonic presentation of ventral pontine stroke, as documented in Sutton Radiology and standard neuroradiology texts. The patient's clinical picture matches exactly: ipsilateral CN VI + CN VII + contralateral motor deficit. ## Why each distractor is wrong - **Foville syndrome**: This is Millard-Gubler PLUS ipsilateral horizontal gaze palsy (from damage to paramedian pontine reticular formation — PPRF). The patient has no gaze palsy, only CN VI and CN VII palsies. - **Lateral pontine syndrome (AICA territory)**: Lateral pontine infarcts present with ipsilateral CN VII + CN VIII (hearing loss, vertigo, nystagmus) + Horner syndrome + cerebellar signs + contralateral pain/temperature loss. This patient has no hearing loss, vertigo, or Horner findings — the syndrome is medial/ventral, not lateral. - **Medial pontine syndrome**: Medial pontine infarcts (paramedian basilar branches) cause ipsilateral CN VI palsy + contralateral hemiplegia, but spare CN VII. This patient has CN VII involvement, ruling out pure medial pontine syndrome. **High-Yield:** Millard-Gubler = ventral pons = CN VI + CN VII + contralateral hemiplegia; add gaze palsy → Foville. [cite: Sutton Radiology — Brainstem Stroke Syndromes; standard neuroradiology references on pontine infarction patterns]
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