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 .