Todd Paresis

Aka: Todd Paresis, Todd's Paralysis, Todd Paralysis, Postseizure Paralysis, Postseizure Paresis

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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

  1. Bedside Glucose
  2. See Cerebrovascular Accident

VIII. Differential Diagnosis

  1. Cerebrovascular Accident
  2. Hemiplegic Migraine
  3. Hypoglycemia

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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