 This is an MR of the brain and face in a one month old with a asymmetric growth on the left side of the face left cheek region. There's thought to be a mass, but if you look at it on this T two weighted image is relatively homogeneously hyper intense. It's hyper intense and T one weighted imaging suppresses on fat suppressed T one weighted imaging. And there's no suspicious enhancement within it. So this looks at first like a lipoma, which is a benign entity. Obviously there may be cosmetic implications, but it's a benign entity. There was more to it than that. So if you look at the T two weighted image, I look at the cerebral hemispheres, the right cerebral hemisphere, it protrudes a little bit over to the left and midline. So if you actually measure it, the right cerebral hemisphere is a little bit larger than the left. The right cerebral hemisphere look at the T two weighted image of the white matter. It's a little bit more hypo intense than the left. Additionally, it's a little bit more hyper intense and T one weighted imaging than the left cerebral hemisphere white matter. And it's noted that in a one month old, this T two hyper intense T one hyper intense appearance of the white matter is normal so while anytime you see an asymmetry it's hard to know what's abnormal. The left hemisphere seems to have a normal milanation pattern. Now, if I go out more superiorly, I'm seeing irregular sulcation pattern. So this patient has what looks like poly microgeria. And again, this hemisphere looks a tiny bit larger. And while there's a little bit more hypo intense appearance on T two and hyper intense appearance on T one weighted imaging of the white matter that can be seen with accelerated milanation. Well, accelerated milanation and asymmetrically enlarged hemisphere or portions of a hemisphere is a finding that can be seen with hemimegalonecephaly. Now hemimegalonecephaly does not even have to involve the whole hemisphere. It can be sub hemispheric hemimegalonecephaly. Then this patient has poly microgeria, which also can be associated with hemimegalonecephaly. So let's take a look again at the cheek mass. So a biopsy of this showed that there was a mutation in the pick three CA gene. What does that mean? Well, the pick three CA gene is noted to be associated with a rare congenital overgrowth syndrome, known as cloves syndrome CLO VES. That is an acronym for, you know, congenital lipomatous overgrowth. There's vascular malformations epidermal nevi and skeletal abnormalities. So this lipomatous overgrowth here of the cheek is actually related to clove syndrome with this pick three CA mutation. We just went through that acronym. And I don't see anything necessarily about the brain malformation, except remember one of them is overgrowth. And you could say that there's overgrowth of the brain, but it's noted that the pick three CA mutation is actually a different mutation in the pick three CA gene is associated with hemimegalonecephaly. So it's not unexpected that someone with clove syndrome may have hemimegalonecephaly. It just happens to be contralateral to the lipomatous overgrowth on the face. So this patient has a facial lipomatous overgrowth. Right sided hemimegalonecephaly with polymagogyria and accelerated myelination in the setting of clove syndrome.