BACKGROUND: cerebral hemiatrophy (CHA) can present in childhood or adulthood, if 
it presents before or after two years of age. This two entities differ in 
etiology, clinical presentation and imaging characteristics. The CHA of 
childhood or Dyke-Davidoff-Masson syndrome, is originated by intrauterine or 
perinatal insults that affect the perfusion of a single cerebral hemisphere, 
manifesting clinically by variable mental retardation, refractory epilepsy, 
facial asymmetry, hemiplegia/hemiparesis or abnormal movements of the 
contralateral extremities and by imaging studies, loss of volume in one cerebral 
hemisphere and ipsilateral compensatory cranial changes such as skull vault 
thickening, elevation of the orbital roof and petreous ridge, also 
hyperpneumatization of the frontal sinus and mastoid cells. Instead, the CHA of 
the adult is multifactorial and by imaging it only manifests as loss of volume 
in one cerebral hemisphere, without compensatory changes in the skull.
CASES REPORT: we present a classic clinical case of CHA secondary to perinatal 
insult and another case of CHA of adulthood secondary to multiple embolic 
strokes in a patient with inactive rheumatic heart disease, commenting the 
imaging differences of these rare clinical entities.