Wednesday, February 11, 2015

Q: 48 year old male with previous history of seizure is in ICU after community acquired pneumonia. Patient missed his regular anti-seizure meds for 2 days. Patient has episode of seizure in ICU. After resolution of seizure, patient is noticed to develop right sided weakness. CT scan is negative. Patient anti-seizure meds are restarted. What is the next step?

A) Start Heparin
B) Start Plavix
C) Insert ICP monitoring device
D) Observation
E) Induce pentobarbital coma

Answer:   D

Patient has most probably developed Todd's Paralysis which is common after seizure. Usually it resolve within 48 hours. Todd's paralysis is a focal weakness  and is usually localized to either the left or right side of the body. Rarely, it affects speech, gaze or vision.

With resolution of seizure, negative CT scan and clear history of missed anti-seizure meds, there is no need at this point for heparin, Plavix, pentobarbital or insertion of ICP device.

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