Dynamic J-Point Elevation Associated with Epileptic Hemiplegia: The Osborn Wave of Todd’s Paralysis

Abstract

This case report exposes a phenomenon which, although proposed, has not been described in clinical literature: transient postictal hemiplegia (Todd’s paralysis) with concomitant electrocardiographic J-point deflection (Osborn waves). Although typically associated with hypothermia, a prominent J-wave on the electrocardiogram (ECG) results from a transmyocardial voltage gradient during ventricular repolarization. Rarely, the Osborn wave may be observed in a non-hypothermic setting such as hypercalcemia or cerebral hemorrhage. Transient postictal hemiplegia has been attributed to localized cerebral hypoperfusion resulting from motor cortex exhaustion following an epileptic seizure. The same central nervous system autonomic dysfunction has been theorized to produce subendocardial hypoperfusion with electrocardiographic change and cardiac troponin T elevation. This is the first described ECG evidence of a dynamically displaced J-point in the setting of postictal hemiplegia.

Keywords

• Todd’s paralysis
• Osborn wave
• J-wave
• Epilepsy
• Stroke
• STEMI
• Hemiplegia
• Postictal
• ACS