Last edited: 1/29/2022

PONS LESIONS
Pons Lesions Medical Editor: Adara Garcia Maestu

OUTLINE
BLOOD SUPPLY TO THE PONS IV) LATERAL PONTINE SYNDROME
I) VENTRAL PONTINE SYNDROME V) LOCKED-IN SYNDROME
II) INFERIOMEDIAL PONTINE SYNDROME VI) SUMMARY TABLE
III) VENTROMEDIAL PONTINE SYNDROME VII) REFERENCES

BLOOD SUPPLY TO THE PONS

Most of the pons is supplied by the basilar artery Other causes of pontine syndromes
o Medial pons→ Paramedian branches
Tumors
o Anterolateral pons→ Short circumferential branches
Demyelination (eg. multiple sclerosis)
Viral infections (eg. rhombencephalitis)

Note: These etiologies are more commonly seen in

When one of these arteries is blocked or hemorrhages, a younger patients
pontine syndrome can occur

I) VENTRAL PONTINE SYNDROME

Figure 1 Structures damaged in Millard-Gubler Syndrome

Also known as Millard-Gubler syndrome

Lesion of the basilar part of the pons

CN VII (facial) fasciculus CN VI (abducens) fasciculus

Carries motor information to muscles of facial expression Carries motor information to the lateral rectus muscle
o Ipisilateral paralysis of the face o Ipsilateral lateral rectus palsy (inability to abduct the
Carries parasympathetic stimuli to nasal, salivary and ipsilateral eye)
lacrimal glands o Medial deviation of the ipsilateral eye
o Ipsilateral loss of salivation and lacrimation Corticospinal fibers
Receives gustatory information from anterior 2/3rds of the
Carry motor information from the cortex to the
tongue
contralateral body
o Changes to taste (ipsilateral loss)
o Contralateral hemiplegia
Receives somatic sensations from the external ear,
middle ear and tympanic membrane
o Loss of sensation in your ears/ear pain

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 II) INFERIOMEDIAL PONTINE SYNDROME

Figure 2 Structures damaged in Foville Syndrome

Also known as Foville Syndrome
Lesion of the basilar and anterior tegmental parts of the pons
Affects the following structures:
CN VII (facial) fasciculus CN VI (abducens) fasciculus
Carries motor information to muscles of facial expression Carries motor information to the lateral rectus muscle
o Ipisilateral paralysis of the face o Ipsilateral lateral rectus palsy (inability to abduct the
Carries parasympathetic stimuli to nasal, salivary and ipsilateral eye)
lacrimal glands o Medial deviation of the ipsilateral eye
Corticospinal fibers
Receives gustatory information from anterior 2/3rds of the
Carry motor information from the cortex to the
tongue
contralateral body
o Changes to taste (ipsilateral loss)
o Contralateral hemiplegia
Receives somatic sensations from the external ear,
middle ear and tympanic membrane Paramedian pontine reticular formation (PPRF)
o Loss of sensation in your ears/ear pain Allows the eyes to follow head movement (when the head
turns to the right, the eyes turn to the right)
Works by sending signals to the ipsilateral abducens
nucleus which stimulates the contralateral
occulomotor nucleus
o Ipsilateral gaze palsy (eyes can’t deviate towards the
side of the lesion)

III) VENTROMEDIAL PONTINE SYNDROME

Figure 3 Structures damaged in Raymond Syndrome

Also known as Raymond Syndrome
Limited lesion to the basilar part of the pons
Damages the following structures:
Corticospinal fibers CN VI(Abducens) CN VII (facial) fasciculus
Carry motor information fascicle: ipsilateral lateral Present in some cases only ( not a common presentation )
from the cortex to the gaze paresis Carries motor information to muscles of facial expression
contralateral body o Ipisilateral paralysis of the face
o Contralateral
Carries parasympathetic stimuli to nasal, salivary and lacrimal glands
hemiplegia
o Ipsilateral loss of salivation and lacrimation
Receives gustatory information from anterior 2/3rd of the tongue
o Changes to taste (ipsilateral loss)
Receives somatic sensations from the external ear, middle ear
and tympanic membrane
o Loss of sensation in your ears/ear pain

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 IV) LATERAL PONTINE SYNDROME

Figure 4 Structures damaged in Marie-Foix syndrome

Also known as Marie-Foix Syndrome
Lesion to the anteolateral part of the pons
Damages the following structures:
Corticospinal fibers If the damage extends further backwards:
Carry motor information from the cortex to the contralateral body Spinal trigeminal nucleus
o Contralateral hemiplegia
Receives sensory information from the ipsilateral
Spinal Lemniscus face
Carries sensory information from the contralateral side of the o Loss of pain, temperature, crude touch,
body pressure and some proprioception of the
o Contralateral loss of pain, temperature, crude touch and ipsilateral face
pressure Cochlear nuclei
Middle Cerebellar Peduncles Receives hearing information from CN VIII
(vestibulocochlear)
o Deafness
o Ipsilateral cerebellar ataxia (loss of muscle co-ordination)

V) LOCKED-IN SYNDROME

Figure 5 Structures damaged in locked-in syndrome

Rare syndrome
Can occur with bilateral lesions of the basal pons
Damages the following structures:
Bilateral Corticospinal fibers
Send motor information to upper and lower limbs Only damaged occasionally
o Quadriplegia (entire body paralysis) Carries motor information to the lateral rectus muscle
(abduction of the eye)
Bilateral Corticonuclear/Corticobulbar fibers
Connects to CN III (oculomotor) nucleus via medial
Send motor information to the nuclei of CN longitudinal fasciculus
IX(glossopharyngeal) and CN X(vagus) o Bilateral internuclear ophthelmaplegia with horizontal
o Paralysis of laryngeal muscles gaze palsy
→ Aphonia (can’t speak)  Loss of eye coordination
 Inability to move eyes side to side
Paramedian Pontine Reticular Formation (PPRF) CN IV(trochlear)
Aka: the center for horizontal gaze Damaged occasionally, affects the superior oblique muscle
Despite damage to all these structures and inability to move or speak, the reticular formation remains intact, menaing
1. these patients can still see, hear, understand and are completely conscious. Hence the name, “locked-in” syndrome,
2. The vertical Gaze and voluntary blinking are intact
3. Cutaneous sensation is intact

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 VI) SUMMARY TABLE

Syndrome Name Structures Affected Symptoms

Ipsilateral face palsy

Ventral Pontine CN VII (Facial) Dry eyes and mouth
Syndrome CN VI (Abducens) Changes to taste
(Millard-Gubler Corticospinal Medial deviation of the
Syndrome) Fibers ipsilateral eye
Contralateral hemiplegia

Ipsilateral face palsy

Inferomedial CN VII (Facial) Dry eyes and mouth
Pontine CN VI (Abducens) Changes to taste
Syndrome Corticospinal Fibers Medial deviation of the
(Foville Paramedian ipsilateral eye
Syndrome) Pontine Reticular Contralateral hemiplegia
Formation (PPRF) Ipsilateral gaze palsy

Ventromedial
CN VI (abducens) Ipsilateral face palsy
Pontine
nucleus Dry eyes and mouth
Syndrome
Corticospinal Fibers Changes to taste
(Raymond
CN VII (Facial) Contralateral hemiplegia
Syndrome)

Contralateral hemiplegia
Corticospinal Fibers Contralateral loss of pain
Medial Lemniscus and temperature
Middle Cerebellar sensations from the body
Lateral Pontine Peduncles Cerebellar ataxia
Syndrome
(Marie-Foix If damage extends If damage extends
Syndrome) posteriorly: posteriorly:
Spinal trigeminal Ipsilateral loss of pain and
nucleus temperature sensations
Cochlear nuclei from the face
Deafness

Bilateral
corticospinal fibers Quadriplegia
Bilateral Aphonia
corticobulbar fibers Bilateral internuclear
Paramedian ophthalmoplegia
Pontine Reticular Horizontal nerve palsy
Locked-in Formation (PPRF)
Syndrome Intact function of:
Occasionally: Hearing, sight,
CN VI (abducens) consciousness and
nucleus cognitive abilities, vertical
gaze, voluntary blinking,
Intact function of: cutaneous sensation
Reticular
Formation

VII) REFERENCES
● https://next.amboss.com/us/article/UR0bmf?q=pontine%20syndr ● Papadakis MA, McPhee SJ, Rabow MW. Current Medical
omes#Z5f7103ba8b182c901e1d7627a9b3b4cf Diagnosis & Treatment 2018. New York: McGraw-Hill
● Sabatine MS. Pocket Medicine: the Massachusetts General Education; 2017.
Hospital Handbook of Internal Medicine. Philadelphia: Wolters ● Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL,
Kluwer; 2020. Loscalzo J. Harrison's Principles of Internal Medicine, Twentieth
● Le T. First Aid for the USMLE Step 1 2020. 30th anniversary Edition (Vol.1 & Vol.2).
edition: McGraw Hill; 2020. ● McGraw-Hill Education / Medical; 2018 Marieb EN, Hoehn K.
● Williams DA. Pance Prep Pearls. Middletown, DE: Kindle Direct Anatomy & Physiology. Hoboken, NJ: Pearson; 2020.
Publishing Platform; 2020. ● Boron WF, Boulpaep EL. Medical Physiology.; 2017.

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 ● Netter FH, Felten DL, Józefowicz Ralph F. Netter's Atlas of
Human Neuroscience. Teterboro, NJ: Icon Learning Systems; 2004.
Netter FH. Atlas of Human Anatomy

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