How can we distinguish postictal Todd’s Paralysis from acute ischemic stroke in the prehospital and early hospital setting?

Abstract

Summary Introduction Acute Ischemic Stroke (AIS) is a medical emergency with focal neurological deficits. Todd’s paralysis (TP) is defined as a transient loss of motor ability and weakness that lasts hours to days and typically occurs after a focal seizure. Given the high prevalence of stroke and the rising availability of reperfusion therapies, timely detection of eligible patients is critical. Pre- and early-hospital differential diagnosis of various conditions with comparable clinical presentations is still difficult. Aim This review discusses Todd’s post-epileptic paralysis, one of the most common stroke mimics (SM), in pre- and early-hospital settings. Discussion and Conclusions The review covers the most critical findings on the TP and its emergency care as a common stroke mimic. Because TP is an excluding diagnosis, the most severe and curable illnesses must be recognised. Since thrombolysis is safe in SM, delaying or withholding medication may be improper when the advantages of treating a stroke mimic outweigh the dangers of treating a stroke mimic.