Todd’s Paresis as a Post Ictal Phenomenon in Post-Traumatic Epilepsy: A Case Report
Highlight: • Todd’s paresis presented as transient hemiparesis in a case of untreated post-traumatic epilepsy. • Proposed pathomechanisms of Todd’s paresis include neuronal exhaustion, active inhibition, and postictal hypoperfusion. • Todd’s paresis was commonly misdiagnosed as acute ischemic st...
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Universitas Airlangga
2025-07-01
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| Online Access: | https://e-journal.unair.ac.id/aksona/article/view/54758 |
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| author | I Gusti Agung Ayu Andra Yusari Ni Made Susilawathi Ni Putu Ayu Putri Mahadewi |
| author_facet | I Gusti Agung Ayu Andra Yusari Ni Made Susilawathi Ni Putu Ayu Putri Mahadewi |
| author_sort | I Gusti Agung Ayu Andra Yusari |
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| description | Highlight:
• Todd’s paresis presented as transient hemiparesis in a case of untreated post-traumatic epilepsy.
• Proposed pathomechanisms of Todd’s paresis include neuronal exhaustion, active inhibition, and postictal hypoperfusion.
• Todd’s paresis was commonly misdiagnosed as acute ischemic stroke due to the similar clinical presentation
ABSTRACT
Introduction: Todd’s paresis is defined as a paralysis state after an epileptic seizure that lasts for several hours to days and recovers completely afterwards. It usually manifests as a transient hemiparesis after a focal or generalized seizure. Todd’s paresis cases and its mechanisms were still widely discussed. Case: A 48-year-old man with history of post-traumatic epilepsy presented with right-sided hemiparesis and facial weakness after a general motor tonic-clonic seizure. The location of the hemiparesis was contralateral to the post-trauma lesion in left frontal lobe which was suspected to be the focus of the seizure. The postictal weakness resolved completely after 30 hours without any specific intervention. It was revealed that the patient had been having several seizures beforehand after the epidural and subdural hematoma due to head trauma. The patient was diagnosed as Todd’s paresis following a post ictal condition in patient with post-traumatic epilepsy. Conclusion: Todd’s paresis should be considered as a diagnosis in patients with seizure and stroke-like syndrome such as hemiparesis due to its similar manifestations, especially if it resolves within hours. Several mechanisms were suggested to be the pathophysiology of Todd’s paresis including neuronal exhaustion, active inhibition, and postictal hypoperfusion. |
| format | Article |
| id | doaj-art-d338530f3cf742c7be937bc416f6fcfc |
| institution | Kabale University |
| issn | 2807-7970 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Universitas Airlangga |
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| series | Aksona |
| spelling | doaj-art-d338530f3cf742c7be937bc416f6fcfc2025-08-20T04:01:57ZengUniversitas AirlanggaAksona2807-79702025-07-0152909410.20473/aksona.v5i2.5475852920Todd’s Paresis as a Post Ictal Phenomenon in Post-Traumatic Epilepsy: A Case ReportI Gusti Agung Ayu Andra Yusari0https://orcid.org/0000-0003-1415-5700Ni Made Susilawathi1https://orcid.org/0000-0002-3166-2440Ni Putu Ayu Putri Mahadewi2Department of Neurology, Universitas Udayana; Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, IndonesiaDepartment of Neurology, Universitas Udayana; Universitas Udayana Hospital, Badung, IndonesiaDepartment of Neurology, Universitas Udayana; Universitas Udayana Hospital, Badung, IndonesiaHighlight: • Todd’s paresis presented as transient hemiparesis in a case of untreated post-traumatic epilepsy. • Proposed pathomechanisms of Todd’s paresis include neuronal exhaustion, active inhibition, and postictal hypoperfusion. • Todd’s paresis was commonly misdiagnosed as acute ischemic stroke due to the similar clinical presentation ABSTRACT Introduction: Todd’s paresis is defined as a paralysis state after an epileptic seizure that lasts for several hours to days and recovers completely afterwards. It usually manifests as a transient hemiparesis after a focal or generalized seizure. Todd’s paresis cases and its mechanisms were still widely discussed. Case: A 48-year-old man with history of post-traumatic epilepsy presented with right-sided hemiparesis and facial weakness after a general motor tonic-clonic seizure. The location of the hemiparesis was contralateral to the post-trauma lesion in left frontal lobe which was suspected to be the focus of the seizure. The postictal weakness resolved completely after 30 hours without any specific intervention. It was revealed that the patient had been having several seizures beforehand after the epidural and subdural hematoma due to head trauma. The patient was diagnosed as Todd’s paresis following a post ictal condition in patient with post-traumatic epilepsy. Conclusion: Todd’s paresis should be considered as a diagnosis in patients with seizure and stroke-like syndrome such as hemiparesis due to its similar manifestations, especially if it resolves within hours. Several mechanisms were suggested to be the pathophysiology of Todd’s paresis including neuronal exhaustion, active inhibition, and postictal hypoperfusion.https://e-journal.unair.ac.id/aksona/article/view/54758human & diseasepathomechanismpost-traumatic epilepsytodd's paresis |
| spellingShingle | I Gusti Agung Ayu Andra Yusari Ni Made Susilawathi Ni Putu Ayu Putri Mahadewi Todd’s Paresis as a Post Ictal Phenomenon in Post-Traumatic Epilepsy: A Case Report Aksona human & disease pathomechanism post-traumatic epilepsy todd's paresis |
| title | Todd’s Paresis as a Post Ictal Phenomenon in Post-Traumatic Epilepsy: A Case Report |
| title_full | Todd’s Paresis as a Post Ictal Phenomenon in Post-Traumatic Epilepsy: A Case Report |
| title_fullStr | Todd’s Paresis as a Post Ictal Phenomenon in Post-Traumatic Epilepsy: A Case Report |
| title_full_unstemmed | Todd’s Paresis as a Post Ictal Phenomenon in Post-Traumatic Epilepsy: A Case Report |
| title_short | Todd’s Paresis as a Post Ictal Phenomenon in Post-Traumatic Epilepsy: A Case Report |
| title_sort | todd s paresis as a post ictal phenomenon in post traumatic epilepsy a case report |
| topic | human & disease pathomechanism post-traumatic epilepsy todd's paresis |
| url | https://e-journal.unair.ac.id/aksona/article/view/54758 |
| work_keys_str_mv | AT igustiagungayuandrayusari toddsparesisasapostictalphenomenoninposttraumaticepilepsyacasereport AT nimadesusilawathi toddsparesisasapostictalphenomenoninposttraumaticepilepsyacasereport AT niputuayuputrimahadewi toddsparesisasapostictalphenomenoninposttraumaticepilepsyacasereport |