Bilateral Facial Colliculus Syndrome MRI

Clinically: 35 year old female with sudden onset slurred speech since two days with associated giddiness, fever.

On neurological examination there was facial Palsy. No signs of internuclear ophthalmoplegia.

MRI BRAIN shows:
Bilateral symmetric abnormal T2 hyperintensity with mild focal parenchymal swelling involving dorsum of Pons at the floor of fourth ventricle.
Area of involvement corresponds to facial colliculus.

Imaging wise differential diagnosis:
Bilateral facial colliculus syndrome due to demyelinating lesion.
Viral infection, Rhombencephalitis.

Suggested CSF for oligoclonal band and serum immunoglobulin in view of Multiple sclerosis.
Antinuclear antibodies in view of autoimmune disease.
Routine CSF for viral infection.

Facial colliculus and facial follicle syndrome

Facial colliculus is an elevation on the floor of fourth ventricle in Pons under which there is a presence No nucleus is located with facial nerve axons traversing over it giving of bump like appearance.

Lesion involving facial colliculus present with Internuclear ophthalmoplegia, abducens nerve, lower motor neuron type of facial nerve palsy with an associated features of medial longitudinal fascicles involvement.
There is important to make note that not symptoms and signs will be present in each and every patient.

Causes of facial colliculus syndrome include demyelination for example multiple sclerosis, viral infection like Rhombencephalitis, tumour whereas it can be secondary to ischaemic infarct in old age patient.
Facial colliculus syndrome secondary to Stroke going to be uni lateral whereas demyelinating lesion will be more or less bilateral.