PHACE syndrome

Last revised by Ryan Thibodeau on 10 Sep 2023

PHACE syndrome, also known as cutaneous hemangioma–vascular complex syndrome or Pascual-Castroviejo type II syndrome, is a phakomatosis that comprises of:

When sternal clefting and/or supraumbilical raphe are also present it is termed PHACES syndrome.

PHACE syndrome is nine times more common in females 9.

Clinical diagnosis of PHACE syndrome requires the presence of a characteristic segmental hemangioma or hemangioma >5 cm on the head (face or scalp) plus 1 major criterion or 2 minor criteria 5

Major criteria anomalies:

  • arterial: 

    • anomaly of major cerebral / cervical arteries (ICA, ACA, MCA, PCA, vertebral, basilar)

    • dysplasia of the large cerebral arteries (tortuosity, kinking, dolichoectasia)

    • arterial stenosis or occlusion with or without moyamoya collaterals

    • absence or moderate-severe hypoplasia of the large cerebral arteries

    • aberrant origin or course of the large cerebral arteries (except common aortic arch variants such as bovine aortic arch)

    • persistent carotid-vertebrobasilar anastomosis (persistent trigeminal, hypoglossal, proatlantal, or otic)

  • structural brain: 

  • ocular: 

  • cardiovascular:

    • aortic arch anomalies (except common variants such as bovine arch)

    • aortic coarctation

    • aberrant origin of subclavian artery

    • aortic aneurysm

  • ventral or midline:

    • sternal defects or supraumbilical raphe

Minor criteria:

The pathogenesis of PHACE syndrome is unknown, and the condition is thought to be sporadic in etiology 9,10. While it has been widely hypothesized that PHACE syndrome may have a genetic etiology through somatic mutation(s) in early embryogenesis, no such mutations have been identified 9,10. No familial cases have been described 11.

Initially, this syndrome was described as an association of large cutaneous hemangiomas of the head and anomalies of the cerebral vasculature by Pascual-Castroviejo in 1978 7,8. Subsequently, the name PHACE syndrome was coined by Ilona Frieden et al 2.

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