Spatial disorientation and the Dyke-Davidoff-Masson syndrome

Dyke-Davidoff-Masson Syndrome: Main clinical and radiological findings- systematic literature review

INTRODUCTION

Dyke-Davidoff-Masson syndrome (DDMS), or cerebral hemiatrophy, was first described in 1933. It is characterised by cerebral injury that causes hypoplasia in one of the cerebral hemispheres. The disease has different clinical degrees and two aetiologies: congenital and acquired. Radiological findings depend on the degree of injury and the patient's age at the time.

OBJECTIVE

To provide information on the main clinical and radiological characteristics of this disease.

METHODS

A systematic review of the PubMed, MEDLINE, and LILACS databases was conducted using only one keyword. Dyke-Davidoff-Masson syndrome. A total of 223 studies were identified, and the results are presented in tables and graphics.

RESULTS

The mean age of the patients was 19.44 (0-83 years), and the majority were male (55.32%). The most common types of epileptic seizures were generalised tonic-clonic seizures (31 cases), focal impaired awareness seizures (20 cases), focal motor seizures (13 cases), focal to bilateral tonic-clonic seizures (nine cases), and focal myoclonic seizures (one case). The main features of the disease were rapid deep tendon reflexes and extensor cutaneous-plantar tendon reflexes (30 cases - 16%), contralateral hemiparesis or hemiplegia (132 cases - 70%), gait alterations (16 cases - 9%), facial paralysis (nine cases - 5%), facial asymmetry (58 cases - 31%), limb asymmetry (20 cases - 11%), delayed developmental milestones (39 cases - 21%), intellectual disability (87 cases - 46%), and language/speech disorders (29 cases - 15%). Left hemisphere atrophy was the most prevalent.

CONCLUSION

DDMS is a rare syndrome, and several questions regarding this disease remain unanswered. This systematic review aims to elucidate the most common clinical and radiological aspects of the disease and emphasises the need for further investigation.

Severe developmental topographical disorientation associated with ADHD and dyscalculia: A case report

We report the clinical case of AB, a right-handed 19-year-old woman who presents severe developmental topographical disorientation, a relatively rare syndrome, leading to difficulties in navigating in familiar (and novel) environments. This symptomatology appears without acquired cerebral damage (MRI described as normal) nor more global cognitive disability (high degree of education achieved). An extensive assessment of spatial cognition with different aspects of underlying cognitive processes is first presented. Second, the patient's preserved cognitive abilities and her major difficulties in calculation, as well as her attention deficit, as seen in a detailed neuropsychological assessment, are reported. For the first time to our knowledge, we show that developmental topographical disorientation can be associated with other developmental cognitive disorders affecting number processing (dyscalculia) and attention (Attention Deficit-Hyperactivity Disorder (ADHD)). We discuss the links between these different cognitive processes in relation to visuo-spatial working memory and magnitude representation, which could represent common denominators for all these syndromes. This case report highlights the importance of thoroughly assessing potentially associated neurocognitive disorders in developmental topographical disorientation. In addition, it highlights the necessity to keep in mind the prevalence of spatial difficulties in the assessment of children and adolescents with other neurodevelopmental syndromes. Finally, this case study raises a new question about the nosology of developmental disorders affecting the visuo-spatial and spatial domains.

Spatial Orientation and Congenital Blindness: A Neuropsychological Approach

Tests of a neuropsychological model for spatial orientation in the absence of vision were developed and administered to 31 children who are congenitally blind. The results supported the model and indicated that some congenitally blind subjects had focal brain damage, sufficient to impair their capacity to be accurately oriented in physical space.

Right cerebral hemiatrophy: neurocognitive and electroclinical features

The purpose of this study was to retrospectively evaluate the cognitive and electroclinical characteristics of right cerebral hemiatrophy (Dyke-Davidoff-Masson syndrome [DDMS]). Cognitive assessments with a particular emphasis on visuospatial functions, electroclinical features, and neuroimaging characteristics were analyzed for five patients with a clinically and neuroradiologically confirmed diagnosis of right-sided DDMS. Intelligence tests revealed mental retardation in all but one. Neuropsychological assessments demonstrated consistent impairments in tasks that have a spatial component (spatial processing and orientation discrimination), whereas attention, executive functions and verbal memory domains were variably impaired. Electroclinically, the main seizure types were simple partial motor, complex partial, and secondarily generalized seizures. Interictal EEG delineated lower amplitudes and slow background activity in the affected hemisphere. Overall, the cognitive performance of patients with DDMS encompasses a broad spectrum of impairments affecting multiple domains. Our findings support the concept that dorsal visual pathways responsible for spatial processing may be lateralized to the right hemisphere.

Developmental topographical disorientation in a healthy subject

We present the case of F.G., a healthy, normally developed 22-year-old male subject affected by a pervasive disorder in environmental orientation and navigation who presents no history of neurological or psychiatric disease. A neuro-radiological examination showed no evidence of anatomical or structural alterations to the brain. We submitted the subject for a comprehensive neuropsychological assessment of the different cognitive processes involved in topographical orientation to evaluate his ability to navigate the spatial environment. The results confirmed a severe developmental topographical disorder and deficits in a number of specific cognitive processes directly or indirectly involved in navigation. The results are discussed with reference to the sole previously described case of developmental topographical disorientation (Pt1; Iaria et al., 2009). F.G. differs from the former case due to the following: the greater severity of his disorder, his complete lack of navigational skills, the failure to develop compensatory strategies, and the presence of a specific deficit in processing the spatial relationships between the parts of a whole. The present case not only confirms the existence of developmental topographical-skill disorders, but also sheds light on the architecture of topographical processes and their development in human beings.

Dyke-Davidoff-Masson syndrome in postcerebral malaria

Dyke-Davidoff-Masson syndrome is a disorder involving hemiatrophy or hypoplasia of 1 cerebral hemisphere secondary to an insult in the developing brain. Often this will manifest with seizures, hemiparesis, mental retardation, and facial changes. Associated with this pathology are the radiologically evident changes, such as thickening of the calvarium, hyperpneumatization of the sinuses, and dilation of the ipsilateral lateral ventricle among others. The following is a case presentation of an 18-year-old female emigrating from Ghana who presented to the emergency department with complaints of seizures diagnosed as being caused by cerebral malaria at 13 years of age. We hypothesize that the cerebral malaria and related vascular occlusion are the causes of her acquired cerebral changes. Included are computed tomography images.

Assessment and treatment of childhood topographical disorientation: A case study

Topographical disorientation refers to individuals who are unable to find their way around large-scale environments in a normal manner. Childhood topographical disorientation is rarely investigated or reported. Treatment of topographical disorientation is also rare with only one reported treatment study in an adult (Davis & Coltheart, 1999) and no known description of treatment in a child. This paper reports a detailed case analysis of CA, a 6-year-old child with topographical disorientation, and a description of a treatment programme focused on training orientation in the school environment. Assessment of CA revealed mild to moderate visual agnosia in conjunction with severe impairments in general spatial learning and memory, topographical new learning and memory, and a total inability to learn new topographical routes. CA was also unable to use a mental image of his environment, a simple visual plan of his environment or a simple visual map, but was able to follow verbally mediated topographical instructions. The treatment programme focused on improving CA's topographical orientation in the school environment. The programme first involved training in recognition of major school buildings and landmarks and then focused on practical training in route finding along commonly used routes in the school environment. Clear benefits from treatment were evident. The assessment and treatment methods employed provide practical and useful ideas for management of this condition in other children.

[Dyke-Davidoff-Masson syndrome: a report of two cases]

Dyke-Davidoff-Masson syndrome is a condition characterized by seizures, facial asymmetry, contralateral hemiplegia or hemiparesis and mental retardation. We report the clinical and imaging features in two patients with epilepsy revealing a Dyke-Davidoff-Masson syndrome. Brain MRI showed unilateral loss of cerebral volume with hypertrophy and hyperpneumatization of the paranasal sinuses and mastoid cells. Ipsilateral fronto-parietal polymicrogyria was present in one patient.

Dyke-Davidoff-Masson syndrome manifested by seizure in late childhood: a case report

The patient was a 19-year-old woman who presented with hemiatrophy and diminished superficial sensation on the left side of her body including her face. She had a past history of tonic-clonic seizures accompanied by left hemiparesis in late childhood. Brain CT demonstrated dilatation of the frontal sinus, calvarial thickening, cerebral hemiatrophy and dilatation of the lateral ventricle on the right side. Brain MRI showed atrophy of the right cerebrum and midbrain and dilatation of the lateral ventricle on T1-weighted images, as well as a high signal intensity area from the parietal to the occipital lobe on T2-weighted images. These findings are suggestive of an episode that may have caused a transient ischemia through the right cerebral hemisphere after the intrauterine period.

Pure topographical disorientation related to dysfunction of the viewpoint dependent visual system

A 70-year-old woman presented with pure topographical disorientation following haemorrhage in the right medial parietal lobe. She could not navigate in the real world despite good ability to draw maps, describe routes, and identify objects and buildings. Her performance on mental rotation, visual memory, and spatial learning tests also was normal. In contrast, she failed totally in a locomotor map test and in a task in which she was requested to judge viewpoints of buildings. Her highly selective topographical disorientation was probably caused by the inability to identify a viewpoint of a particular building. The lesion may have disconnected the association between the spatial information processed in the lateral parietal lobe and the visual memory mediated by the limbic system, which seems to be important for viewpoint dependent analysis.