controlling refractory epilepsy is a challenge . identification of the cause for epilepsy is essential in planning management . there are many syndromes which are associated with refractory epilepsies and some of them are identified by their imaging characteristics . ( 1 ) ddms is a rare condition characterized clinically by variable degrees of facial asymmetry , seizures , contralateral hemiparesis and mental retardation in association with the classical radiological findings of asymmetry of cerebral hemispheric growth with atrophy on one side , ipsilateral osseous hypertrophy and hyper pneumatization of sinuses ( 1 - 3 ) . cerebral hemiatrophy with homolateral hypertrophy of the skull and sinuses result in facial asymmetry and elevation of the sphenoid wing and petrous ridge . ( 1 ) the brain reaches half of its adult size during the first year of life and reaches three - fourths of that size by the end of the third year . as it enlarges , the brain presses outward on the bony tables and is partly responsible for the gradual enlargement and general shape of the adult head . when the brain fails to grow properly , the other structures tend to direct their growth inward ; thus , accounting for the enlargement of the frontal sinus , increased width of the diploic space and the elevations of the greater wing of sphenoid and the petrous ridge on the affected side . these changes can occur only when brain damage is sustained before three years of age . ( 4 ) both sexes and any of the hemispheres may be affected but male gender and left hemisphere involvement are more frequent . age of presentation depends on the time of neurologic insult , and characteristic changes may be seen only in adolescence . the clinical findings may be of variable degree depending on the extent of the brain injury . varying degrees of atrophy of one half of the body , sensory loss , speech and language disorder , mental retardation or learning disability and psychiatric manifestations like schizophrenia may also be present . a proper history , thorough clinical examination and radiologic findings provide the correct diagnosis . ( 5 ) the etiology of ddms may be roughly divided into two categories of congenital or acquired . in the congenital type , the cerebral vascular insult takes place in - utero , and the entire cerebral hemisphere is characteristically hypo plastic . there is also a shift of midline structures toward the side of the disease and the sulcul prominence replacing the gliotic tissue is absent ; and this feature differentiates it from cerebral hemiatrophy which occurs in early life . in the acquired type , trauma , infection , vascular abnormalities or intracranial hemorrhage in the perinatal period or shortly thereafter may be responsible for the condition . ( 6 ) the manifestations of ddms may be so subtle to be overlooked on plain radiographs ; however , ct / magnetic resonance imaging ( mri ) is the diagnostic modality of choice . ( 3 ) a possible etiological relation between cerebral atrophy and seizures has been reported in three different studies in india ( 5 , 7 and 8) this condition needs to be differentiated from the basal ganglia germinoma , sturge - weber syndrome , linear nevus syndrome , fishman syndrome , silver - russell syndrome and rasmussen encephalitis . it is noteworthy to mention that the assessment of the complete clinical history and examination along with radiological features can only provide the diagnosis of the dyke - davidoff - masson syndrome ( 6 , 9 ) . the treatment of ddms is symptomatic and should target convulsions , hemiplegia , hemiparesis and learning difficulties . children with intractable disabling seizures and hemiplegia are the potential candidates for hemispherectomy with a success rate of 85% in the carefully selected cases . prognosis is better if hemiparesis occurs after the age of 2 and in the absence of prolonged or recurrent seizures ( 5 ) .
dyke - davidoff - masson syndrome ( ddms ) is a syndrome associated with refractory epilepsy . 
 ddms is a rare syndrome characterized by seizures , facial asymmetry , contralateral hemiplegia and mental retardation . 
 the characteristic radiologic features are cerebral hemiatrophy with homolateral hypertrophy of the skull and sinuses . 
 the case was an 18 years old female with seizures , hemiparesis of the right side and mental retardation who was diagnosed with ddms based on computed tomography .