Raccoon Eyes and Neuroblastoma

A nine-month-old was seen for failure to thrive and bruising around the eyes. A nine-month-old girl was seen for failure to thrive and bruising around the eyes. On physical examination, she was noted to have periorbital ecchymosis, dysconjugate gaze, dilated and fixed pupils, and an abdominal mass. Examination of an open-biopsy specimen of the abdominal mass revealed neuroblastoma. A photograph of the child's face (Panel A) shows bilateral periorbital ecchymosis (“raccoon eyes”) with dysconjugate gaze; the sclera appear normal. An axial T₁-weighted, contrast-enhanced magnetic resonance image of the brain through the orbits (Panel B) shows an extensive metastasis at the skull base, involving the sphenoid bone and the temporal and zygomatic.