Todd's Paresis — SCE Neurology MCQ

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EasyEpilepsy & Seizure DisordersTodd's ParesisSCE Neurology

A 40-year-old man is admitted with a generalised tonic-clonic seizure. Post-ictally, he has a dense right hemiparesis that gradually resolves over 45 minutes. His pre-ictal examination was normal. MRI brain is unremarkable. What is this transient post-ictal deficit called?

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Correct answer: D — Todd's paresis (post-ictal paresis)

Todd's paresis (Todd's paralysis) is a transient focal neurological deficit (most commonly hemiparesis) occurring after a seizure. It typically resolves within minutes to hours (usually <24 hours) and reflects temporary neuronal exhaustion in the epileptogenic cortex. It is important to recognise as it can mimic stroke. If the deficit does not resolve, neuroimaging is essential to exclude an underlying structural lesion or acute stroke. A: MRI is normal, excluding stroke. C: TIA does not follow a seizure. D: The temporal relationship to the seizure and gradual resolution is characteristic of Todd's. E: Hemiplegic migraine has migrainous features.

Reference: NICE NG217 (2025); ILAE Guidelines