STURGE -WEBER SYNDROME COMPLICATED BY TODD’S PALSY: A PEDIATRIC CASE REPORT

Sanjana U. M., Janaki R. Torvi, Adarsh G. S.*, Siddappa Dandinavar, Preeti V. Kulkarni, Chetan Savant, Venkatrao H. Kulkani

Background: Sturge-Weber Syndrome (SWS) is a rare congenital neurocutaneous disorder characterized by facial capillary malformations, leptomeningeal angiomas, and neurological manifestations including seizures, hemiparesis, developmental delay, and cognitive impairment. Todd's palsy is a transient postictal neurological deficit that may mimic acute cerebrovascular events and can complicate the clinical course of patients with SWS. Case Presentation: A 4-year-old female child with a known history of Sturge-Weber Syndrome and recurrent focal seizures presented with decreased movement of the right upper and lower limbs. The patient had multiple previous hospital admissions for convulsive episodes and was receiving antiepileptic therapy including carbamazepine, clobazam, oxcarbazepine, and brivaracetam. Clinical examination revealed right-sided hemiparesis with preserved consciousness and intact cranial nerve function. Systemic examination was unremarkable. Laboratory investigations demonstrated moderate anemia (hemoglobin 8.2 g/dL), leukocytosis (17,070 cells/mm³), reactive thrombocytosis (5.37 lakh/mm³), and mild hyponatremia (130.2 mEq/L). Neuroimaging findings were consistent with Sturge-Weber Syndrome. Based on the temporal relationship to seizure activity and the absence of acute intracranial pathology, a diagnosis of Todd's palsy secondary to focal seizure in a child with SWS was considered. The patient received supportive care, optimization of antiepileptic therapy, nutritional management, and neurological rehabilitation. Discussion: Recurrent seizures in SWS may result in transient postictal neurological deficits such as Todd's palsy, posing diagnostic challenges due to their resemblance to stroke-like episodes. Early recognition is essential to avoid unnecessary interventions and facilitate appropriate management. Associated factors such as anemia, malnutrition, and electrolyte disturbances may further lower the seizure threshold and influence neurological outcomes. Conclusion: This case highlights the importance of considering Todd's palsy in children with Sturge-Weber Syndrome presenting with acute hemiparesis following seizure episodes. Prompt diagnosis, effective seizure control, correction of contributing metabolic abnormalities, and multidisciplinary management are crucial for improving clinical outcomes and quality of life in affected patients.