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Case report
Todd’s paresis following vasovagal syncope provoked by tilt-table testing
  1. David Moloney1,2,
  2. Laura Perez Pérez-Denia1,3 and
  3. Rose Anne Kenny1,3
  1. 1Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
  2. 2Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
  3. 3Department of Medical Physics, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
  1. Correspondence to Dr David Moloney; moloned3{at}tcd.ie

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.

  • epilepsy and seizures
  • cardiovascular medicine
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Footnotes

  • Contributors DM and RAK conceived of the idea. DM wrote the manuscript with input from all authors. LPP-D generated the graphs from the raw data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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