Facial colliculus syndrome

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Facial colliculus syndrome refers to a constellation of neurological signs due to a lesion at the facial colliculus, involving:

abducens nerve (CN VI) nucleus
facial nerve (CN VII) fibres at the genu
medial longitudinal fasciculus

Clinical presentation

lower motor neuron facial nerve palsy proximal to geniculate ganglion hence including loss of sensation of the taste in anterior two-thirds of the tongue and hyperacusis
diplopia
horizontal conjugate gaze palsy

Note that all symptoms are not invariably present in every patient.

Pathology

Aetiology

Causes of facial colliculus syndrome vary by age:

young
- tumour
- demyelination (e.g. MS)
- viral infection (e.g. rhombencephalitis)
older
- vascular (e.g. stroke, see case 1)

The facial palsy is due to interruption of the ipsilateral facial nerve fibres at the genu as they arch behind the abducens nerve (CN VI) nucleus (thus forming the colliculus).

The conjugate gaze palsy is due to involvement of innervation not only to the ipsilateral abducens nerve to lateral rectus, but also to the interneurons projecting into the medial longitudinal fasciculus which contribute innervation of the contralateral medial rectus (thus internuclear ophthalmoplegia). This is not however always the case (see case 1).

Radiographic findings

Usually only detected on MRI as a small focus of high signal in facial colliculus at the floor of 4th ventricle on DWI or T2/FLAIR sequences.

-</ul><p>The facial palsy is due to interruption of the ipsilateral facial nerve fibres at the genu as they arch behind the <a href="/articles/abducens-nerve">abducens nerve (CN VI)</a> nucleus (thus forming the colliculus).</p><p>The conjugate gaze palsy is due to involvement of innervation not only to the ipsilateral abducens nerve to lateral rectus, but also to the interneurons projecting into the medial longitudinal fasciculus which contribute innervation of the contralateral medial rectus (thus <a href="/articles/">internuclear ophthalmoplegia</a>). This is not however always the case (see case 1).</p><h4>Radiographic findings</h4><p>Usually only detected on MRI as a small focus of high signal in <a href="/articles/facial-colliculus">facial colliculus</a> at the floor of 4th ventricle on DWI or T2/FLAIR sequences. </p><h4>See also</h4><ul><li><a href="/articles/brainstem-stroke-syndromes">brainstem stroke syndromes</a></li></ul>
+</ul><p>The facial palsy is due to interruption of the ipsilateral facial nerve fibres at the genu as they arch behind the <a href="/articles/abducens-nerve">abducens nerve (CN VI)</a> nucleus (thus forming the colliculus).</p><p>The conjugate gaze palsy is due to involvement of innervation not only to the ipsilateral abducens nerve to lateral rectus, but also to the interneurons projecting into the medial longitudinal fasciculus which contribute innervation of the contralateral medial rectus (thus <a title="Internuclear ophthalmoplegia" href="/articles/internuclear-ophthalmoplegia">internuclear ophthalmoplegia</a>). This is not however always the case (see case 1).</p><h4>Radiographic findings</h4><p>Usually only detected on MRI as a small focus of high signal in <a href="/articles/facial-colliculus">facial colliculus</a> at the floor of 4th ventricle on DWI or T2/FLAIR sequences. </p><h4>See also</h4><ul><li><a href="/articles/brainstem-stroke-syndromes">brainstem stroke syndromes</a></li></ul>

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