Todd's paresis following vasovagal syncope provoked by tilt-table testing

BMJ Case Rep. 2020 Jun 7;13(6):e234402. doi: 10.1136/bcr-2020-234402.

Abstract

A 38-year-old woman presented with a history of recurrent episodes of transient loss of consciousness (TLOC) with seizure-like activity and post-TLOC left sided paresis. Electroencephalogram and MRI of the brain were normal, and events were not controlled by anti-convulsant therapy. Tilt testing produced reflex mixed pattern vasovagal syncope, with exact symptom reproduction, including bilateral upper and lower limb myoclonic movements and post-TLOC left hemiparesis that persisted for 27 min. A witness for the tilt event confirmed reproduction of patients 'typical' TLOC event. Syncope is the most frequent cause of TLOC. Myoclonic movements during syncope are not uncommon and can be misdiagnosed as epilepsy. It is rare to experience paresis after syncope, which in this case, lead to misdiagnosis and unnecessary anti-convulsant treatment.

Keywords: cardiovascular medicine; epilepsy and seizures.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Blood Pressure Determination / methods
  • Diagnosis, Differential
  • Electroencephalography / methods*
  • Epilepsies, Myoclonic / diagnosis*
  • Female
  • Heart Rate / physiology
  • Humans
  • Paralysis / diagnosis*
  • Patient Care Management / methods
  • Patient Education as Topic / methods*
  • Syncope, Vasovagal* / diagnosis
  • Syncope, Vasovagal* / physiopathology
  • Syncope, Vasovagal* / therapy
  • Tilt-Table Test* / adverse effects
  • Tilt-Table Test* / methods
  • Unconsciousness / diagnosis
  • Unconsciousness / etiology