FIRST EPISODE OF GENERALIZED TONIC SEIZURE FOLLOWED BY TODD’S PARESIS IN 17 YEARS OLD PATIENT WITH TURNER SYNDROME
Leni Lukman,Melanie Widjaja,Nata Pratama Hardjo Lukito
Universitas Pelita Harapan
Background : There is limited literature reporting first episode of seizure followed by Todd’s paresis in turner syndrome without any structural lesions.
Case Presentation Summary : A 17 years old girl came to the hospital with chief complaint of first episode of generalized tonic seizure without fever. The seizure lasted for 30 seconds and the patient was unconscious with upward gaze. Any kinds of traumas were denied. At the age of 5, she was diagnosed with inflammatory bowel disease confirmed by colonoscopy. Later at the age of 9, she was diagnosed with Turner Syndrome but received no intervention. On physical examination she has short stature of 120 cm (<5th percentile), 17.5 kg weight (<5th percentile), high blood pressure (140/80 mmHg) and no signs of puberty (Tanner I). Shortly after seizure the patient developed right-sided hemiparesis (4 out of 5 muscle strength in right upper and lower extremities) and right 7th central cranial nerve paresis improved after 24 hours post-seizure and completely resolved within 36 hours. Laboratory result showed microcytic hypochromic anemia (hemoglobin 5.6 g/dL). Faeces analysis showed occult blood in stool. Electrolytes (sodium, potassium and chloride), urinalysis, EEG, CT scan and MRI examination were unremarkable. She was admitted to the hospital for observation and received 1000 ml transfusion of packed red cell. The patient was sent home after 5 days seizure-free with hemoglobin of 10.5 g/dl.
Learning Points/Discussion : Todd’s paresis can manifest in 13% of seizure cases and also linked with epilepsy, however first episode of seizure with normal EEG result in this patient lead us to address hypoxic-anemic as the etiology of the seizure with epilepsy as differential diagnosis.