Postictal Todd's Paralysis Associated with Focal Cerebral Hypoperfusion on Magnetic Resonance Perfusion Studies

Background—The exact underlying physiology of postictal motor deficits, known as Todd's paralysis, is not well understood and its vascular perfusion physiology is not well studied. Reversible postictal perfusion abnormalities have been sparsely described in the literature. Methods—We report abnormal brain magnetic resonance perfusion maps in a 9-year-old boy who presented with postictal left hemiparesis. This case correlates postictal hemispheric cerebral hypoperfusion with clinical evidence of Todd's paralysis. Conclusions—Our case provides an insight into the potential pathophysiology mechanism underlying Todd's paralysis and the practicality of magnetic resonance perfusion studies in localizing an epileptogenic zone in the postictal patient.