Crossed cerebrocerebellar diaschisis in Dyke–Davidoff–Masson syndrome

Abstract

Dear Sir, I read an interesting article on magnetic resonance imaging depiction of crossed cerebrocerebellar diaschisis in Dyke–Davidoff–Masson (DDMS) syndrome by Gupta et al.[1] There are still a lot of case reports in various journals from time to time and only rarely some case series.[2] Even then, there are many new or unresolved issues in this diverse syndrome. One such issue is being resolved up to some extent by the present twin case report. Here, I would like to share my views and experience: In one of our study, we had a very remarkable finding in the form of cerebral hemispheric plus cerebellar atrophy in nine patients out of a total of 28 patients of DDMS, of which three patients had diffuse bilateral and one had crossed cerebellar atrophy (CCA) which was associated with left cerebral hemiatrophy[3] In an earlier study, it was concluded that in patients with epilepsy and destructive insults early in life, the extent of the supratentorial lesion as well as the antecedent of status epilepticus plays a major role in the pathogenesis of CCA. Recurrent seizures do not seem to be relevant to the development of CCA[4] The authors in the present case report have concluded that CCA in the setting of DDMS is ipsilateral when insult is before the age of 1 month and is contralateral when the insult is after this age due to differences in anatomy during development, which was consistent in their patients, as both of them had history of insult after 1 month of age A question arises out of our case series that three patients who had diffuse bilateral cerebellar atrophy, where to place them about time of injury according to the authors' explanation of 1 month demarcating age for insult Other remarkable findings of our study included, hippocampal sclerosis (16%), dystonia, hemiparkinsonism, mirror movement, and DandyWalker syndrome, with a conclusion that DDMS can present protean clinicoradiological manifestation, cerebellar atrophy, hippocampal sclerosis, and phenytoin intolerance may be one of them. The drawback with our study was lack of functional neuroimaging. Hence, the aim of further case reports and case series should be on such important aspects of various pathophysiological correlates of varied manifestation so as to manage and take preventive steps to avoid the dreaded disabilities in such patients. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.