Dyke–Davidoff–Masson syndrome (DDMS)

Dyke–Davidoff–Masson syndrome (DDMS)

Dyke–Davidoff–Masson syndrome (DDMS) was first defined based on the X-rays of patients suffering from hemicerebral atrophy, accompanied by ipsilateral endocranial thickening 

 CT is the method of choice for detecting cerebral hemiatrophy 

 Features of DDMS in the skull include ---

1.calvarial thickening, due to hypertrophy of the inner table of the frontal bone;

2. enlargement of the paranasal sinuses and mastoid air cells;

3. hypoplasia of the frontal and/or middle cranial fossa;

4. loss of convolutional markings in the inner table

4. elevation of the petrous ridge and of the greater wing of the sphenoid.

 These changes are thought to be the result of compensation for the unilateral loss of cerebral volume .

GUIDLINES FOR USE OF CONTRAST IN CT BRAIN

Brain computed tomography

• The routine study of the head is made in the axial plane.
•  Slice thickness was originally 5–10 mm for the supratentorial compartment and 5 mm or less for the posterior fossa, mainly in an attempt to reduce beam-hardening artefact.
•  Multidetector CT can provide thinner cuts and many more options, including multiplanar reconstructions. 
• Window widths and levels are set to maximize contrast between grey and white matter, and are kept constant from patient to patient. 

CONTRAST

• 
  
• A plain unenhanced study always should be performed first.
•  IV contrast enhancement shows areas of blood–brain barrier breakdown within the brain, which is a very nonspecific phenomenon; it can make small lesions much more conspicuous.
•  Guidelines for contrast medium use include: 
• (A) when plain CT is abnormal and there is a reasonable expectation that enhancement may improve diagnostic accuracy;
•  (B) when lesions are suspected close to the skull base or in the posterior fossa (this includes pituitary and imaging for visual failure);
•  (C) when staging for carcinomas known frequently to metastasize to the brain;
•  (D) when suspecting focal intracranial infections; and 
• (E) when meningeal disease is suspected such as caused by sarcoidosis or metastases (e.g. cranial nerve palsies, especially if multiple).
• An IV injection of iodinated contrast medium------ dose equivalents of 15–30 g of iodine generally are given; some clinics use two or even three times that dosage. 

Reference---

Adam: Grainger & Allison's Diagnostic Radiology, 5th ed.

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