Todd's Paralysis

[fma08]

One of my co-workers had a patient with this the other day. Anyone else had one or have any information about it? All I can find on it is very basic information. Any hints for distinguishing it from a stroke? (Besides a history of epilepsy). Thanks for the help!

 

[usafmedic45]

Any hints for distinguishing it from a stroke? (Besides a history of epilepsy).

Really there is nothing that is going to change the treatment in the field. It's just a quirk some epileptics have. The major differentiating factor is the length of time the paresis remains present. Rather than "paralysis"....it's more correctly called "Todd's paresis" or postictal paresis since most patients with it do not demonstrate true paralysis of the affected extremity.

 

[fma08]

Really there is nothing that is going to change the treatment in the field. It's just a quirk some epileptics have. The major differentiating factor is the length of time the paresis remains present. Rather than "paralysis"....it's more correctly called "Todd's paresis" or postictal paresis since most patients with it do not demonstrate true paralysis of the affected extremity.

Probably not, but in the case of the patient my co-worker had who was exhibiting left sided paresis, it looks an awful lot like a stroke. Slurred speach, arm drift, and faicial droop. It would be helpful in notifying the hospital with correct information, calling them in as an epileptic vs. a stroke victim.

 

[usafmedic45]

It would be helpful in notifying the hospital with correct information, calling them in as an epileptic vs. a stroke victim.

You don't make that differentiation. Call it in as a possible CVA and mention that the initial event was a seizure and the patient has a history of epilepsy. Let the doc who has more education and experience, more technology and better malpractice coverage handle sort out what is fully going on. As my medical director said at a CQI meeting when asked about this sort of thing, "I'll be upset if you call for us to prepare for something worse than what you show up with. You don't want to see how pissed I will be if you play it off as something non-consequential and it turns out to be something bad."

 

[mycrofft]

Like Lance said...

"Don't get on the radio tellin' me about fractured tibia or fibula. If it's broke, it's broke; splint it and git it in".

Todd's sounds like something to get a medicalert (or, like me, dogtags) for, to avoid unnecessary TPA's.

Of course, the pt MIGHT be experiencing a CVA or TIA after all. Quacks and walks like a chicken etc.

 

[got_shoes]

It could be both

This type of issue seems to be a cryiptogenic disease or of idiopathic progression. In some cases of seizure, stroke may be the result of the the condition. Something like 15% of seizure pt's have this condition, and can last anywhere from a few hours to upwards of 48.

 

[rescue99]

"Don't get on the radio tellin' me about fractured tibia or fibula. If it's broke, it's broke; splint it and git it in".

Todd's sounds like something to get a medicalert (or, like me, dogtags) for, to avoid unnecessary TPA's.

Of course, the pt MIGHT be experiencing a CVA or TIA after all. Quacks and walks like a chicken etc.

I've seen Todd's several times. Although it isn't always present, it does happen quite often in conjunction with seizures in post CVA patients. Seems more common in post bleed patients but that might be coincidental. Been a time or two where I did have a really difficult time deciding wheather there was a new CVA involved. Of course nothing is official until a diagnosis has been made.