Seizure

Todd Paresis

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Todd Paresis, Todd's Paralysis, Todd Paralysis, Postseizure Paralysis, Postseizure Paresis

  • Definitions
  1. Todd Paresis
    1. Focal onset Seizure, typically leading to Hemiparesis
  • Background
  1. First described by Robert Bentley Todd in 1849
  • Epidemiology
  1. Follows 13% of Seizures
  • Pathophysiology
  1. Multiple postulated mechanisms
    1. Prolonged refractory period after Seizure and secondary repeated depolarizations
    2. Local inhibition by surrounding Neurons as a protective reflex
    3. Tissue hypoperfusion from Seizure
  • Signs
  1. Focal Seizure precedes weakness
  2. Motor weakness (from mild to complete paralysis) in limb opposite the side of the Seizure
  3. Other neurologic presentations
    1. Extraocular Movement deficit (Gaze Palsy)
    2. Aphasia
    3. Sensory deficit
    4. Visual Field Deficit
  • Labs
  1. Bedside Glucose
  2. See Cerebrovascular Accident
  • Differential Diagnosis
  1. Cerebrovascular Accident
  2. Hemiplegic Migraine
  3. Hypoglycemia
  • Imaging
  • First Episode
  1. Evaluate as Cerebrovascular Accident
    1. Exception: Clear history of Focal Seizure preceding event and known history of Todd's Paralysis
  2. CT Head
  3. CT Angiogram Head and Neck
  4. Consider MRI Brain
  • Evaluation
  1. See Cerebrovascular Accident
  2. Known history of Todd's Paralysis may circumvent significant workup
  • Course
  1. Residual neurologic deficits may last up to 24-36 hours (mean 15 hours)
  • References
  1. Mastriana, Pay and Taylor (2019) Todd Paresis, StatPearls, accessed 6/6/2019
    1. https://www.ncbi.nlm.nih.gov/books/NBK532238/