A 5year old female with a history of right sided hypertonia and frequent seizures presented to our department for investigation. She had previously undergone two MRI scans, one in 2004 which demonstrated significant loss of volume of the left hemisphere, a loss of deep and subcortical white matter, markedly dilated left lateral ventricle. This MRI gave a diagnosis of cerebral palsy. In 2007 she underwent an additional brain MRI at the Royal Children’s Hospital which demonstrated no significant change from 2004 images and the report was suggestive of an old antenatal/perinatal ischaemic event as the cause of her brain condition. In September of 2008 she was investigated in our department looking for a focus of epilepsy. She underwent a 99mTc-ECD Ictal SPECT/CT study and an 18F-FDG Inter-ictal PET brain study which were later both fused with an additional MRI performed in September of 2008 at the RCH. The PET and SPECT datasets were both corrected for attenuation using their own low dose CT acquisitions and then they were fused with the T2 MRI images. The fused images demonstrated multiple epileptic foci in both sides of the brain with the left side being the more severe of the two. Based on the result of findings of the PET/CT and SPECT/CT fused with the MRI and the failure of medication and dietary strategies, the treating team has decided to perform a partial hemispherectomy of the left side of the brain to alleviate the seizures.