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Summer is here, what's new and Norton's corner.

Evening team! Welcome to the eleventh instalment of our weekly dose. Hopefully everyone has managed t
Summer is here, what's new and Norton's corner.
By Pulsenotes • Issue #11 • View online
Evening team!
Welcome to the eleventh instalment of our weekly dose. Hopefully everyone has managed to catch a bit of the sunny weather in-between tuning in to our lectures! It’s a shorter one this week - Ben on days, Norton’s on nights and I’m in the midst of my masters dissertation. However we have had time to update you on what’s new and Norton’s here with another clinical gem.
Enjoy our content? - Remember to tell your friends about us!

Check out Norton's meningitis lecture this Friday!
Check out Norton's meningitis lecture this Friday!
What's new this week?
LIVE webinars - what we’ve got coming up…
We’re providing FREE LIVE WEBINARS over the summer.
This week Norton has a double-billing! He’ll be there to take you through more important medical conditions
  1. Friday 17th July 11:00 BST - Pulsenotes LIVE: Meningitis. Tune in Friday as Norton takes you through the recognition and treatment of meningitis.
  2. Sunday 19th July 11:00 BST - Pulsenotes LIVE: Bradyarrhythmias. And he’s back Sunday to cover Bradyarrythmias, an update of a classic Pulsenotes LIVE lecture.
Remember - recordings of all these LIVE events will be available for members that aren’t able to make it!
New stuff…
We’ve just uploaded recordings of the following LIVE events for you to watch at your leisure!
  • Necrotising fasciitis
  • Stroke
We’ve been growing our library and this week we’ve added these:
And there are many new question sets too!
  • Pericarditis
  • Multiple sclerosis
  • Osteoporosis
  • Osteoarthritis
  • Hodgkin lymphoma
  • Non-hodgkin lymphoma
Norton's Corner
Todd’s paresis
Todd’s paresis describes post-ictal motor deficits. This means development of weakness / paralysis of part of the body following a focal seizure. It is a common stroke mimic and medical school exam favourite. History (as always!) is key.
In clinical practice, the classic presentation is weakness of the contralateral limb to the area of seizure activity. This may range from mild weakness to overt paralysis (hence the concern about stroke!). Depending on the area of brain affected by seizure activity, a range of other clinical features may be present including speech or sensory disturbances.
The condition occurs following focal seizures. This may be secondary to a pure focal seizure, where the seizure activity remains localised to a single area. Alternatively, it can occur due to a focal-onset seizure that can extend to other areas of the brain.
The condition itself is theorised to develop due to ‘exhaustion’ of the cerebral area affected by vigorous depolarisation. This leads to a prolonged refractory state in that area. Another theory is the presence of prolonged local inhibition, which acts to prevent further seizure activity. Alternatively, it may be due to reduced blood flow from vasoconstriction, which limits the function of the area.
Recovery is usually within minutes to days and the vast majority within 36 hours. Many patients, depending on brain area involved, risk factors and collateral history, will need to have stroke excluded. MRI helps differentiate from an acute stroke and sometimes reversible post-ictal perfusion abnormalities will be identified. Another differential to consider is hemiplegic migraine, which classically presents as a severe, unilateral headache associated with hemiparesis.
Remember, the devil is in the detail, a collateral history about any potential seizure activity is important to come to the diagnosis.
Benjamin Norton (@medicalreg)
Final words
Remember to get in contact with any questions, suggestions, or topics that you wish to be covered!
Thanks for reading, remember to tell your friends, and see you next week!
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