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Post-ictal, lateralized hyperkinetic motor behavior.

Beck B, Chang GY - Epilepsy Behav Case Rep (2012)

Bottom Line: Todd's palsy, a transient focal weakness after a seizure, is a highly accurate clinical sign indicative of a contralateral, cerebral epileptic focus.In contrast, a transient, lateralized hyperkinetic motor behavior from a contralateral, hemispheric ictal focus has not been emphasized as a localizing clinical sign.The following case demonstrates that transient hyperkinetic behavior occurs as a post-ictal phenomenon and may have a localizing value, as in Todd's palsy.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA.

ABSTRACT
Recognition of a transient, focal neurologic dysfunction after a seizure is important when evaluating patients with idiopathic epilepsy. Todd's palsy, a transient focal weakness after a seizure, is a highly accurate clinical sign indicative of a contralateral, cerebral epileptic focus. In contrast, a transient, lateralized hyperkinetic motor behavior from a contralateral, hemispheric ictal focus has not been emphasized as a localizing clinical sign. The following case demonstrates that transient hyperkinetic behavior occurs as a post-ictal phenomenon and may have a localizing value, as in Todd's palsy.

No MeSH data available.


Related in: MedlinePlus

A. DWI obtained 5 days after admission reveals a subtle, increased signal over the large area of the right cortical ribbon, most prominent over the hippocampus (arrow). Right thalamic involvement is more prominent (arrow). The ADC map reveals a subtle low signal consistent with cytotoxic edema (not shown). B. FLAIR sequence on the same day reveals a higher signal mainly over the right hippocampus and ipsilateral thalamus.
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f0005: A. DWI obtained 5 days after admission reveals a subtle, increased signal over the large area of the right cortical ribbon, most prominent over the hippocampus (arrow). Right thalamic involvement is more prominent (arrow). The ADC map reveals a subtle low signal consistent with cytotoxic edema (not shown). B. FLAIR sequence on the same day reveals a higher signal mainly over the right hippocampus and ipsilateral thalamus.

Mentions: A 46-year-old woman with chronic seizure disorder was brought to the emergency room after 3 episodes of generalized tonic-clonic seizures. She was given intravenous lorazepam, a loading dose of fosphenytoin, and intubated. The follow-up EEG that was obtained several hours later disclosed right-sided, semi-rhythmical, large-amplitude spikes consistent with partial status epilepticus. The examination next day disclosed an awake, intubated patient who followed a simple command of “show me your right thumb” without any difficulty. There was no evidence of gaze deviation or nystagmus. There was no abnormal facial movement, but the left arm demonstrated continuous, semi-purposeful movements with frequent grabbing of the bedcover but without tonic–clonic or rhythmical components. When instructed not to move the left hand, she mouthed “I am trying,” but within seconds, her movements returned. Similarly, the left foot demonstrated occasional, semi-purposeful ankle movements. Two days later, now extubated, she fed herself with the right hand but continued with left lateralized hyperkinetic motor behavior (LHMB). When she was asked to show the left little finger, her response was delayed but appropriate. When she was asked to grab the pen that was already placed in her left palm, she had poor control and was unable to hold the pen more than a second. There was no obvious left-sided hemineglect, feeling of alieness or sensory loss. The follow-up EEG demonstrated background rhythm slowing over the right hemisphere but no epileptiform activity. The new brain MRI demonstrated patchy increased signal over the right cortical ribbon, along with right thalamic hyperintensity (Figs. 1A and B). Five days after the onset of the right hemispheric, partial status epilepticus, the left-sided hyperkinetic motor movements resolved with subtle, left wrist extensor weakness.


Post-ictal, lateralized hyperkinetic motor behavior.

Beck B, Chang GY - Epilepsy Behav Case Rep (2012)

A. DWI obtained 5 days after admission reveals a subtle, increased signal over the large area of the right cortical ribbon, most prominent over the hippocampus (arrow). Right thalamic involvement is more prominent (arrow). The ADC map reveals a subtle low signal consistent with cytotoxic edema (not shown). B. FLAIR sequence on the same day reveals a higher signal mainly over the right hippocampus and ipsilateral thalamus.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4150675&req=5

f0005: A. DWI obtained 5 days after admission reveals a subtle, increased signal over the large area of the right cortical ribbon, most prominent over the hippocampus (arrow). Right thalamic involvement is more prominent (arrow). The ADC map reveals a subtle low signal consistent with cytotoxic edema (not shown). B. FLAIR sequence on the same day reveals a higher signal mainly over the right hippocampus and ipsilateral thalamus.
Mentions: A 46-year-old woman with chronic seizure disorder was brought to the emergency room after 3 episodes of generalized tonic-clonic seizures. She was given intravenous lorazepam, a loading dose of fosphenytoin, and intubated. The follow-up EEG that was obtained several hours later disclosed right-sided, semi-rhythmical, large-amplitude spikes consistent with partial status epilepticus. The examination next day disclosed an awake, intubated patient who followed a simple command of “show me your right thumb” without any difficulty. There was no evidence of gaze deviation or nystagmus. There was no abnormal facial movement, but the left arm demonstrated continuous, semi-purposeful movements with frequent grabbing of the bedcover but without tonic–clonic or rhythmical components. When instructed not to move the left hand, she mouthed “I am trying,” but within seconds, her movements returned. Similarly, the left foot demonstrated occasional, semi-purposeful ankle movements. Two days later, now extubated, she fed herself with the right hand but continued with left lateralized hyperkinetic motor behavior (LHMB). When she was asked to show the left little finger, her response was delayed but appropriate. When she was asked to grab the pen that was already placed in her left palm, she had poor control and was unable to hold the pen more than a second. There was no obvious left-sided hemineglect, feeling of alieness or sensory loss. The follow-up EEG demonstrated background rhythm slowing over the right hemisphere but no epileptiform activity. The new brain MRI demonstrated patchy increased signal over the right cortical ribbon, along with right thalamic hyperintensity (Figs. 1A and B). Five days after the onset of the right hemispheric, partial status epilepticus, the left-sided hyperkinetic motor movements resolved with subtle, left wrist extensor weakness.

Bottom Line: Todd's palsy, a transient focal weakness after a seizure, is a highly accurate clinical sign indicative of a contralateral, cerebral epileptic focus.In contrast, a transient, lateralized hyperkinetic motor behavior from a contralateral, hemispheric ictal focus has not been emphasized as a localizing clinical sign.The following case demonstrates that transient hyperkinetic behavior occurs as a post-ictal phenomenon and may have a localizing value, as in Todd's palsy.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA.

ABSTRACT
Recognition of a transient, focal neurologic dysfunction after a seizure is important when evaluating patients with idiopathic epilepsy. Todd's palsy, a transient focal weakness after a seizure, is a highly accurate clinical sign indicative of a contralateral, cerebral epileptic focus. In contrast, a transient, lateralized hyperkinetic motor behavior from a contralateral, hemispheric ictal focus has not been emphasized as a localizing clinical sign. The following case demonstrates that transient hyperkinetic behavior occurs as a post-ictal phenomenon and may have a localizing value, as in Todd's palsy.

No MeSH data available.


Related in: MedlinePlus