The Stroke Mimic: Todd’s Paresis as a Postictal Phenomenon in Sturge–Weber Syndrome

Background: Sturge–Weber syndrome (SWS) is a rare neurocutaneous disorder characterized by leptomeningeal angiomatosis, which causes chronic cortical ischemia and frequent seizures. Todd’s paresis—a transient postictal focal weakness. Aims: To evaluate the incidence, duration, and clinical characteristics of Todd’s paresis in patients with SWS. Material and Method: A retrospective review of adult patients diagnosed with SWS and epilepsy and hemiparesis. Results: In SWS, Todd’s paresis most commonly presents as transient hemiparesis contralateral to the seizure focus. Key findings often include that these episodes can last from minutes to several days. Discussion: The pathophysiology likely involves a combination of neuronal exhaustion and postictal hypoperfusion, which is exacerbated by the impaired venous drainage typical of SWS. It is critical to differentiate these transient episodes from “stroke-like episodes” in SWS, which are typically more pronounced and last longer than 24 hours. Conclusion: Todd’s paresis is a frequent postictal phenomenon in SWS that requires careful clinical monitoring. Recognizing its transient nature can prevent unnecessary aggressive interventions while underscoring the need for optimized antiseizure therapy to minimize progressive neurological damage. Publication History Article published online: 15 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India