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Hemimegalencephaly (HME) is one of the rare malformations of cortical development that can present in children and in adults with refractory seizures. One of the localized forms of HME is posterior quadrantic dysplasia (PQD). This entity commonly involves hypertrophy of the parieto-temporo-occipital lobes with periventricular signal changes on imaging. Presentation is with focal seizures in children and in adults. We present here a 24-year-old man presenting with recurrent left focal seizures who was found to have PQD on imaging. He was started on anticonvulsants with improvement in his symptoms. This report aims to highlight the characteristic imaging findings and clinical features of PQD.