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