A prolonged postictal motor phenomenon as a Todd’s paralysis: A case report and mini-review

Introduction: Todd's paralysis is a regressive deficit following an epileptic seizure. Often the duration of this symptom does not exceed 36 hours. Rarely the deficit extends over time beyond these deadlines. We report the case of a prolonged todd’s paralysis. We discuss the pathophysiological mechanism of todd's paralysis and the factors predicting its persistence beyond the usual time limits. Case report: We report the case of a 46-year-old patient with no notable pathological history. She presented with recurrent focal epileptic seizures in a feverish context. His neurological examination showed a left hemiplegia. The cerebral MRI performed in our patient showed a left frontal lesion in hyposignal T1, hypersignal T2, without enhancement after injection, without radiological lesion on the diffusion sequences, this lesion is suggestive of cortical developmental anomaly. The analysis of cerebrospinal fluid is normal. Viral serologies are normal. The motor deficit regressed after a month, despite the absence of vascular, tumor or infectious lesions explaining the symptomatology. Brain MRI performed at 3 months of evolution showed the same brain lesion already described. Despite the prolonged delay the diagnosis of todd's paralysis was made based on the regressive character of the motor deficit and the absence of etiology which could explain the clinical presentation. Conclusion: The todd’s syndrom is a set of post ictal negative signs. It  represents a differential diagnosis of certain neurological emergencies which require invasive interventions or a specific heavy treatment. Documenting relevant clinical signs, especially with atypical features would help clinicians to avoid inappropriate conducts.