Abstracts

Rationale: Focal cerebral edemas may be induced by seizures and mimic other cerebral lesions. In addition, seizures could be accompanied with symptoms of ischemic strokes. For these reasons, it is sometimes difficult to distinguish Todd s paralysis from a sequelae of ischemic stokes. A 64 years old man had contusional tissue losses in the both frontal areas and the left occipital area of the brain due to a traffic accident occurred 4 years ago. After the accident, mild hemiparesis of the left side was remained. His first attack of seizure occurred one and half years ago. He suffered serial attacks of generalized tonic-clonic seizures on a day. We controlled the seizures with intravenous diazepam. Left hemiparesis of Grade I remained after the seizure control and persisted.Methods: We did studies of brain MRI and MR angiography for him twice, to investigate the cause of his severe hemiparesis of the left side. The MRIs and MR angiographies were taken 3 days after the event and one and half months later. We used MRI machine of AVANTO 1.5T (Siemens, Erlangen, Germany)Results: On the MRI taken 3 days after the event, high signal intensities were observed in the medial frontal gyrus and the precentral gyrus of the right hemisphere in diffusion-weighted images and T2-weighted images. The lesions were limited only in the cortical and subcortical area. We considered the possibilities of both of cerebral edema and ischemic stroke. His hemiparesis of the left side started to improve from the 12th hospital day and reached to the previous state on the 14th hospital day. We took a follow-up brain MRI one and half months later. The high signal intensities disappeared. Based on the signal changes, we concluded that the abnormal findings were the lesions of seizure-induced cerebral edema.Conclusions: Seizure-induced cerebral edema may be misdiagnosed as ischemic strokes, especially when the lesions occur according to the vascular territories explaining the hemiparesis and it persist longer than usual duration of Todd s paralysis. Follow-up brain MRI studies may be mandatory to differentiate between Todd s paralysis and ischemic strokes in complex cases.