LETTER TO THE EDITOR - FUNCTIONAL

Striking asymmetry in cerebral metabolismin Dyke-Davidoff-Masson (DDM) syndrome: FDG-PETand MRI correlation

Sandip Basu & Arun Chouhan

Received: 8 December 2012 /Accepted: 13 December 2012 /Published online: 10 January 2013# Springer-Verlag Wien 2013

Dear Editor,In this communication, the striking FDG-PET imaging fea-ture in Dyke-Davidoff-Masson is illustrated. Given the rar-ity of this condition, this unique finding of cerebralhypometabolism needs to be recognized in the parlance ofclinical PET imaging. A 10-year-old girl presented withuncontrolled seizure in the form of myoclonic jerks of theleft upper limb (despite being on three-drug regimen), men-tal retardation, learning disabilities, and left-sided hemipa-resis. MRI of the brain (Fig. 1) revealed hemiatrophy ofright cerebral hemisphere and ex vacuo dilatation of the

right lateral ventricle. There was thickening of the overlyingcalvarium. Brain FDG-PET (Fig. 2a and b) demonstratedgross hypometabolism seen in the entire right side of the brain,which was consistent with the MRI findings of rightcerebral hemiatrophy. Additionally, neck muscle hyper-metabolism was noted, interpreted to be related to theuncontrolled myoclonic jerks in the early morning onthe day of the PET study, though during the study thepatient was seizure-free.

In DDM, the striking asymmetry in glucose metabo-lism between the two cerebral hemispheres on FDG-

S. Basu (*) :A. ChouhanRadiation Medicine Centre, Bhabha Atomic Research Centre,Tata Memorial Hospital Annexe, Jerbai Wadia Road, Parel,Mumbai 400 012, Indiae-mail: drsanb@yahoo.com

Acta Neurochir (2013) 155:519–521DOI 10.1007/s00701-012-1604-x

Fig. 1 Coronal T2-weightedMRI demonstrating hemiatro-phy of right cerebral hemi-sphere with dilatation of rightlateral ventricle

Fig. 2 a Brain FDG-PET MIP images demonstrating gross hypometabo-lism seen in the entire right side of the brain (arrow in the coronal slice andthe right-sided MIP image). Also noted is neck muscle hypermetabolism(arrow in the right-sidedMIP image), whichwas related to the uncontrolledmyoclonic jerks in the early morning on the day of the PET study. The

patient was seizure-free during the FDG uptake period. Brain PETscanwasdone 60 min after i.v. injection of 331 MBq of 18F-FDG, using a whole-body full-ring dedicated BGO PET camera. Images were reconstructedusing a standard iterative algorithm (OSEM). b Brain FDG-PET transaxialslices demonstrating hypometabolism in the right cerebral hemisphere

520 Acta Neurochir (2013) 155:519–521

PET is consistent with the pathophysiology of the dis-ease and the MRI findings of hemiatrophy. To date,only two such reports exist in the peer-reviewed litera-ture [1, 2].

Conflicts of interest None.

References

1. Hsin YL, Chuang MF, Shen TW, Harnod T (2011) Temporo-spatialanalyses define epileptogenic and functional zones in a case ofDyke-Davidoff-Masson syndrome. Seizure 20(9):713–716

2. Kulkarni K, Sperling MR, Intenzo C (2005) Positron emissiontomography in Dyke-Davidoff-Masson syndrome. Clin Nucl Med30(9):625–627

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