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Stroke
Published in Henry J. Woodford, Essential Geriatrics, 2022
Seizures may cause symptoms that are mistaken for stroke. Following an ictal episode, there may be poor recollection of the event and associated transient weakness in the affected limbs (Todd paresis). A further complicating factor is that some strokes provoke seizures at their onset. In people with no history of stroke, the onset of seizures after the age of 60 is associated with an increased risk of cerebrovascular disease (see page 426).135 Symptoms of seizures tend to be ‘positive' – resulting in additional phenomena such as jerking movements or hallucinations, compared to stroke that tends to cause ‘negative' symptoms – loss of functions such as sensation or power. An MRI scan should be performed in people with suspected seizures to exclude a structural lesion that may not be detected on CT scanning. Transient epileptic amnesia (see next section) is a form of epilepsy that can mimic TIAs.
Practice Paper 6: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
Partial motor seizures arise in the pre-central gyrus. They are characterized by jerking and spasm of the contralateral motor areas and may spread to one side of the whole body. Attacks that begin in one area and spread gradually are known as a Jacksonian march. These seizures can last hours, and prolonged episodes may result in post-seizure paralysis (Todd’s paresis). Partial sensory seizures arise in the sensory cortex and cause tingling and electric sensations in the contralateral face and limbs. Versive seizures occur with frontal lobe epilepsy and are characterized by forced deviation of the eyes to the opposite side of the seizure.
Symptoms of Neurological Disease
Published in John W. Scadding, Nicholas A. Losseff, Clinical Neurology, 2011
Tim Fowler, Nick Losseff, John Scadding
In complex partial seizures, the term complex refers to impairment of awareness during attacks. By contrast, in simple partial seizures, a focal discharge may occur without loss of awareness so that in a simple partial motor seizure there may be contralateral jerking of the thumb spreading into the arm and perhaps the corner of the mouth on the same side, without disturbance of consciousness. After such a focal motor attack, there may be a temporary weakness in the affected limb – a Todd’s paresis.
Acute foot drop secondary to lumbar disc prolapse after seizure
Published in British Journal of Neurosurgery, 2022
Mohamed Abdalla, Abteen Mostofi, Anan Shtaya, Francis G. Johnston
Differential diagnoses for the foot drop related to his initial presentation included intracerebral haemorrhage from rupture of the then presumed AVM – particularly given its parasagittal location close to the foot area of the primary motor cortex – or Todd’s paresis following further seizure activity, or a vertebral fracture. However, the presence of clinical features of radiculopathy elicited on detailed neurological examination including a positive Lasègue test, loss of the ankle jerk reflex, absence of upper motor neuron signs, and L5-S1 dermatomal sensory loss indicated an acute radiculopathy secondary to the initial seizure. This warranted further investigation with MRI of the lumbosacral spine which confirmed the presence of a large disc prolapse with radicular compression. Furthermore, cerebral DSA subsequently excluded arteriovenous shunting or a nidus, precluding haemorrhage.
Clinical considerations and assessment of risk factors when choosing endovascular thrombectomy for acute stroke
Published in Expert Review of Cardiovascular Therapy, 2020
Ankur Wadhwa, Raed Joundi, Bijoy Menon
After the arrival of the patient to the Emergency Department (ED) the initial steps include rapid assessment and stabilization of the vital parameters and focused history with emphasis on premorbid status, time of onset, comorbidities, and contraindications to thrombolysis. The use of “Stroke Code “ implementation in hospitals has been shown to increase the rate of timely treatment [26] . A screening examination is performed in parallel with the National Institute of Health stroke scale (NIHSS) unless more focused exam is indicated. Stroke symptom severity can be categorized as mild, moderate or severe (NIHSS <6, 6–13, and >13, respectively) [27], while being cognizant of the potential for disability despite low NIHSS, due to aphasia or dominant arm weakness. Stroke mimics are common, and include focal seizures or Todd’s paresis, metabolic abnormalities, complex migraines, subdural hemorrhages, intracranial malignancies, peripheral vertigo, and functional neurological disorders. Although thrombolysis in such patients is usually safe with low risk of bleeding [28], rapid imaging will help to further exclude mimics, assist in diagnosis of stroke and large vessel occlusion, and facilitate the appropriate treatment.
Neurocysticercosis: the good, the bad, and the missing
Published in Expert Review of Neurotherapeutics, 2018
Arturo Carpio, Agnès Fleury, Matthew L. Romo, Ronaldo Abraham
It is also known that clinical manifestations are different according to age. Most children with NC have mild-to-moderate symptomatology and single lesions; seizures are more frequent in children, and intracranial hypertension and headaches are more frequent in adults [38,45]. Most children with NC have a single transitional or enhancing cyst, also named solitary cysticercus granuloma (SCG). SCG is a common finding in people with newly identified seizures in endemic countries. These individuals, mainly children and young adults, have some benign and transitory clinical manifestations, predominantly partial or partial secondary generalized seizures, and occasionally Todd’s paresis or focal neurological deficits. Clinical and radiologic features consistent with a diagnosis of SCG have been well described elsewhere [38,46]. Resolution of the SCG tends to occur spontaneously, since the parasite is already in the degenerative phase and will eventually disappear or become calcified.