II. Definitions

  1. Todd Paresis
    1. Focal onset Seizure, typically leading to Hemiparesis

III. Background

  1. First described by Robert Bentley Todd in 1849

IV. Epidemiology

  1. Follows 13% of Seizures

V. 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

VI. 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

VII. Labs

VIII. Differential Diagnosis

IX. 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

X. Evaluation

  1. See Cerebrovascular Accident
  2. Known history of Todd's Paralysis may circumvent significant workup

XI. Course

  1. Residual neurologic deficits may last up to 24-36 hours (mean 15 hours)

XII. References

  1. Mastriana, Pay and Taylor (2019) Todd Paresis, StatPearls, accessed 6/6/2019
    1. https://www.ncbi.nlm.nih.gov/books/NBK532238/

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Ontology: Todd Paralysis (C0234544)

Concepts Sign or Symptom (T184)
MSH D010243
SnomedCT 66264000
English Paralysis, Todd's, Postseizure paralysis, Paralysis, Todd, Todd's Paralysis, Todds Paralysis, Todd paresis, todd's paralysis, todd paralysis, todd's paresis, todds paralysis, todd's paralysis (diagnosis), Postictal paralysis, Todd's paralysis, Todd's paresis, Todd's paresis (finding), Todd; paralysis, paralysis; Todd, Todd Paralysis
Italian Paralisi post-ictus, Paralisi di Todd
Dutch paralyse van Todd, Todd; paralyse, paralyse; Todd, postictale paralyse
German Todd-Paralyse, Nachschlafparalyse
Portuguese Paralisia de Todd, Paralisia pós-íctica
Spanish Parálisis de Todd, parálisis postconvulsiva (hallazgo), parálisis de Todd, parálisis de Todd (hallazgo), parálisis postconvulsiva, parálisis posconvulsiva, parálisis postictal, Parálisis postictal
Japanese 発作後麻痺, トッド麻痺, ホッサゴマヒ, トッドマヒ
French Paralysie de Todd, Paralysie post-critique, Paralysie épileptique post-critique
Czech Pozáchvatová obrna, Toddova paralýza, Toddova paréza
Hungarian Todd-féle paralysis, Postictalis paralysis
Norwegian Todds paralyse, Todds lammelse