Post-ictal Todd paralysis

Case contributed by Dr Henry Knipe


Left hemiparesis and neglect. Followed by 10 minute seizure.

Patient Data

Age: 90 years
Gender: Female

No acute intracranial hemorrhage identified. Focal hypodensities in the left lentiform nuclear and left corona radiata likely represent chronic lacunar infarcts. Grey-white differentiation is otherwise preserved. No mass lesion. Ventricular size, sulcal pattern and basal cisterns are all unchanged. No bony abnormality demonstrated.

Increased CBV/CBF and reduced TMax/MTT in the right temporal and right parietal lobes in keeping with hyperperfusion. 

Basilar fenestration. No aneurysms or large vessel filling defect identified. Asymmetric caliber of the M3/M4 branches in the right temporoparietal region.

Case Discussion

The CT perfusion demonstrates hyperperfusion localized to the right temporal and parietal lobes, which correspond with the patient's symptoms. It was presumed that the first seizure was not witnessed with only the left hemiparesis evident. 

The main differential diagnosis is that of luxury perfusion in subacute ischemic infarct, however, there are no changes of established infarct on the non-contrast CT brain, no large vessel thrombus on the CTA and CT perfusion in luxury perfusion shows prolonged MTT/Tmax. Also, a follow-up MRI (not shown) did not demonstrate any evidence of infarct. 

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Case information

rID: 57172
Published: 13th Dec 2017
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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