Facial colliculus syndrome

Changed by Henry Knipe, 11 Oct 2017

Updates to Article Attributes

Body was changed:

Show markup changes

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~~younger patients
- tumour
- demyelination (e.g. multiple sclerosis)
- viral infection (e.g. rhombencephalitis)
older patients
- 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~~However, 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.

~~-<li>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</li>~~
~~-<li>diplopia</li>~~
+<li>lower motor neuron <a title="facial nerve palsy" href="/articles/facial-palsy">facial nerve palsy</a> proximal to <a title="Geniculate ganglion" href="/articles/geniculate-ganglion">geniculate ganglion</a> hence including loss of sensation of the taste in anterior two-thirds of the <a title="Tongue" href="/articles/tongue">tongue</a> and hyperacusis</li>
+<li><a title="diplopia" href="/articles/diplopia">diplopia</a></li>
~~-<strong>young</strong><ul>~~
+<strong>younger patients</strong><ul>
~~-<li>demyelination (e.g. <a href="/articles/multiple-sclerosis">MS</a>)</li>~~
+<li>demyelination (e.g. <a title="Multiple sclerosis" href="/articles/multiple-sclerosis">multiple sclerosis</a>)</li>
~~-<strong>older</strong><ul><li>vascular (e.g. stroke, see case 1)</li></ul>~~
+<strong>older patients</strong><ul><li>vascular (e.g. stroke)</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>
+</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">internuclear ophthalmoplegia</a>). However, this is not always the case.</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>

Tags changed:

refs

Sections changed:

Syndromes

ADVERTISEMENT: Supporters see fewer/no ads

{"current_user":null,"inclusions":[{"imageId":27926541,"studyId":56300,"caseSlug":"abducens-and-facial-cranial-nerves-and-nuclei","caption":"Figure 1","thumbnail":"https://prod-images-static.radiopaedia.org/images/27926541/6e2d986764fcee36bd2683a42d8cff_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"not_applicable"},{"imageId":5822,"studyId":6575,"caseSlug":"sixth-cranial-nerve-infarct","caption":"Case 1: infarct","thumbnail":"https://prod-images-static.radiopaedia.org/images/5822/b7b8bc5c9a5163787943b092a7c99d_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":14778848,"studyId":40679,"caseSlug":"demyelination-with-bilateral-facial-colliculus-involvement","caption":"Case 2: demyelination","thumbnail":"https://prod-images-static.radiopaedia.org/images/14778848/839db6efd1ca5fe3891c5fb78143ae_big_gallery.jpg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":57022218,"studyId":116736,"caseSlug":"facial-colliculus-syndrome","caption":"Case 3: infarct","thumbnail":"https://prod-images-static.radiopaedia.org/images/57022218/10._big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":62932814,"studyId":138917,"caseSlug":"facial-colliculus-syndrome-1","caption":"Case 4: demyelination","thumbnail":"https://prod-images-static.radiopaedia.org/images/62932814/fcaae244f80e264d2d7c1ddf3eed6390de3d3c7e701f05a77b0cb21c6b35d2de_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":65257148,"studyId":148108,"caseSlug":"facial-colliculus-syndrome-3","caption":"Case 5: Facial colliculus hemorrhage ","thumbnail":"https://prod-images-static.radiopaedia.org/images/65257148/4ad4e9de7bd615f4f6916cd9d1a64cbfed5ed5b6feeccc8cbbf3a81910b384d7_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":65810720,"studyId":149895,"caseSlug":"facial-colliculus-syndrome-2","caption":"Case 6: infarction","thumbnail":"https://prod-images-static.radiopaedia.org/images/65810720/77f55db7b55e782467b7262734fd8211d9817b08d5c14069f329fc5f7cad5466_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"}],"ddx_inclusions":[],"lang":"us"}