Contralateral oculomotor nerve palsy associated with PHACES syndrome

A 13-month-old boy presented to the pediatric ophthalmology clinic at BC Children’s Hospital for strabismus assessment. On examination he had a right facial hemangioma, left ptosis, and left exotropia and hypotropia. Magnetic resonance imaging and magnetic resonance angiography of his head demonstrated posterior cerebral artery tortuosity producing mild mass effect on the left oculomotor nerve. Oculomotor nerve palsies are a rare manifestation of PHACES syndrome, with multiple possible mechanisms, including cerebellar hypoplasia or vascular anomalies.