Vertebrobasilar artery dolichoectasia manifesting as Millard-Gubler syndrome in a young acute ischemic stroke

Introduction: Vertebrobasilar dolichoectasia (VBD) is an arterial disease characterized by dilatation, elongation, and tortuosity of the vertebral basilar arteries. VBD can generate intracranial hemorrhage, compression brainstem, ischemic stroke as most common presentation. Millard-Gubler syndrome (MGS) a pontine-crossed affecting pons at level facial nerve nucleus. We present unusual case posterior circulation presenting MGS due to VBD. Observation: A 50-year-old man, with medical history high blood pressure, was hospitalized after 20 hours transient dizziness, left numbness, diplopia. On examination, he had right hemiparesis Babinski. Deep tendon reflexes were present. Cranial nerves examination showed abducens paresis peripheral palsy. computed tomography (CT) imaging pontine infarct dilated artery. Brain MRI tortuous vertebrobasilar system touching acoustico-facial complex signal intensity involving anterolateral small cerebellar hemorrhage. Paraclinical tests total cholesterol bilateral carotid artery atherosclerosis without stenosis. The patient received aspirin, atorvastatin anti-hypertensive agents. Two weeks his admission, there resolution mild residual hemiparesis. Discussion: arteriopathy unknown etiology. Clinical symptoms in patients are various including brainstem cranial compression, stroke. uncommon occurring lesion be caused tumor, cavernous angioma, neurocysticercosis, cerebral infarction. coexistence rarer. Conclusion: Our provides evidence that may presented secondary Therapeutic management requires careful balancing benefits risks.