neurocysticercosis is the most common parasitic infection of central nervous system and result from infection with the intermediate stage of taenia solium . in india , cysticercosis is highly prevalent and cns involvement is seen in 60%90% of infested patient .
cerebrum and cerebellum are common sites but may involve brainstem , basal ganglion , thalamus , and lateral sinus .
seizures are the commonest presenting feature in majority but can present with headache , focal deficits , hydrocephalus , and raised intracranial pressure .
we report a case of pontomedullary neurocysticercosis presenting with left vi and vii cranial nerve palsy of lower motor neuron type and contralateral hemiplegia , i.e. , millard gubler syndrome , which is not reported till date .
a 7 year girl presented in outpatient department with history of vomiting and deviation of angle of mouth to right side for 3 days .
there was no history of fever , headache , seizures , altered sensorium , diplopia , nasal regurgitation of feeds , trauma , ear discharge , rash , recent vaccination , and history of contact with an open or treated case of tuberculosis .
examination of patient revealed palsy of vi and vii cranial nerve of left side with right - sided grade iii / v weakness , upper motor neuron type , of upper and lower limbs .
her right - sided babiniski 's sign was positive with exaggerated deep tendon reflexes on same side .
his complete blood count cbc , x - ray chest , blood glucose , electrolytes , liver and renal function tests were normal .
mantoux test was negative at 72 h. cerebrospinal fluid study showed cells 8/mm protein ; 48 mg / dl , and glucose was 68 mg / dl .
contrast - enhanced computed tomograph ( cect ) of cranium revealed single - ring enhancing lesion , with eccentric dot and perilesional edema at pontomedullary area of brain stem suggestive of inflammatory granuloma with possibility of neurocysticercosis [ figure 1 ] . magnetic resonance imaging ( mri ) of brain showed a well - defined ring enhancing lesion with thick rim noted in pontomedullary area of brain stem [ figure 2 ] , which appeared hypointense on t1-weighted and hyperintense on t2-weighted images .
flair images showed suppression of internal signal with mild perilesional edema ; further suggestive of neurocysticercosis in its colloidal - vesicular stage .
coronal cect image showing solitary ring enhancing lesion , with eccentric scolex , in pontomedullary area mri of cranium showing thick cyst wall enhancement with mild perilesional edema , depicting colloidal 
vesicular stage of cysticercosis in pontomedullary area patient was administered 20% mannitol ( 1 gm / kg / dose i.v .
8 hourly for 48 h ) , dexamethasone ( 0.5 mg / kg / day for 2 days ) , and then prednisolone 2 mg / kg / day along with acetazolamide at 75 mg / kg / day . on 3 day of steroid , oral albendazole at 15 mg / kg / day
steroid was stopped after 7 days and patient was discharged on oral albendazole which was to continue for 28 days and advice of physiotherapy . at discharge , there was no vomiting but deviation of angle of mouth and right - sided weakness persisted .
she was called for follow - up after 15 days and found to have no deviation of angle of mouth and weakness .
patient is doing well at 1 and 3 months of follow - up with no clinical evidence of cranial nerve palsy and hemiparesis .
unusual manifestations are stroke , visual loss , ataxia , dystonia , dementia , and hydrocephalus .
intraventricular ( 5%10% ) and meningeal cysticerosis are associated with hydrocephalus , signs of meningeal irritation , and raised intracranial pressure .
we here report a case of neurocysticercosis presenting as left vi and vii cranial nerve palsy of lower motor neuron type and contralateral hemiplegia , i.e. , millard gubler syndrome , which is unreported in literature .
ct scan and mri are useful in anatomical localization of cysts , but mri cranium is more sensitive in picking up active lesions .
our case fulfilled the imaging absolute diagnostic criteria ( histologic demonstration of the parasite from biopsy of a brain or spinal cord lesion , cystic lesions showing the scolex on ct or mri , and direct visualization of subretinal parasites by funduscopic examination ) .
therefore , all patients with multiple cysts should receive treatment with steroid to reduce intracranial pressure and edema ; thereafter cysticidal drug , i.e. , albendazole .
our patient improved and became asymptomatic with steroid treatment and albendazole . recognizing this clinical entity would avoid unnecessary antituberculous treatment and surgical intervention .
cysticercosis is common in tropical countries including india but neurocysticercosis of brain stem is rare .
 neurocysticercosis is a common childhood neurological illness in india . 
 a variety of presentations have been reported in the literature , including weber syndrome . 
 neurocysticercosis , manifesting as millard gubler syndrome , have not been reported in literature . 
 therefore , we report a child presented to us with millard gubler syndrome due to pontomedullary neurocysticercosis and was treated successfully . 
Introduction
Case Report
Discussion