L Chen, et al SWS was made according to the clinical and neuroi- maging characteristics. His left superficial temporal artery was ligated and the port-wine nodules were excised by neurologic surgeons. Subsequently, his episodes of epilep- sy ceased. DISCUSSION The incidence of SWS is three percent in patients with a facial port-wine hemangioma2. There is an increased risk of SWS with involvement of the ophthalmic division of the trigeminal nerve. Facial port-wine hemangiomas, whether or not associated with SWS, usually have a sharp midline demarcation, although some extension over the midline has been observed3. Computed tomography angiography, MRI, and CT are the best modalities to demonstrate the vascular malformation, the impaired cerebral venous drainage, and the atrophy of one hemisphere and calcifications, respectively. Atrophy and calcifications are considered to be an indirect conse- quence of chronic ischemia of the cortex due to vascular stasis in the area of leptomeningeal angioma. Recent ad- vances in neuroimaging have provided important insights into the progression of neurologic injury that occurs as a result of impaired blood flow. Important limitations exist, however, as currently the early diagnosis and exclusion of SWS is impaired by the poor sensitivity of imaging in the newborn period and early infancy1. Epilepsy, hemiparesis, mental retardation, and ocular problems were the most 552 Ann Dermatol Fig. 1. Clinical photograph (panel A) and patient computed tomography and CDA radiological data (panel B and C). frequent and severe features of patients with SWS. Limited intelligence and social skills, poor aesthetic appearance, and epilepsy complicate the integration of the patients. The clinical severity of this case is not the originality of our paper, because no relationship was observed between the size of the facial port-wine hemangiomas and the se- verity of the brain lesion4,5. Symptoms depend upon the extent and location of the venous dysplasia. Early onset of epilepsy and poor response to medical treatment, bilateral cerebral involvement, and unilateral severe lesions are in- dicative of a poor prognosis4. Early surgery is more likely to improve developmental outcome, although, in some in- stances, therapies aimed at obliterating port-wine he- mangiomas to minimize cosmetic blemishes may worsen blood stasis within the brain and potentially exacerbate neurologic symptoms6,7. Considering the complications that may be emerged during the treatment, especially the patient’s own possible apprehension of the condition, it is imperative that the diagnostician and surgeon have thor- ough knowledge of this syndrome. In this case, the episodes of epilepsy from birth had been ignored and separated from SWS by his physicians, which led to delayed treatments for nearly 50 years. As we said above, the clinical severity does not represent the origi- nality of this case. Rather, this case illustrates the im- portance of careful examination of patients of any age with hemangiomas in the trigeminal nerve with con- comitant episodes of epilepsy. Such patients require year- ly neuroimaging examinations. Thorough knowledge of