Background: Though Todd's phenomenon (TP) is a relatively rare occurrence, its correct identification is of key diagnostic and therapeutic importance as a stroke mimic. Here we describe a case of isolated gaze palsy as a manifestation of TP, discuss periictal gaze abnormalities as lateralizing sign involving the frontal eye field (FEF), and present a narrative literature review. Methods: We reviewed the main features of the case and conducted a structured literature search of TP and gaze palsy using PubMed. We restricted the search to publications in English, Spanish, French, and German. Case presentation: A 71-year-old male with a history of right frontotemporal subarachnoid hemorrhage was admitted to the Emergency Department of our institution after suffering a first unprovoked focal to bilateral tonic-clonic seizure with ictal gaze deviation to the left. Cranial imaging showed no signs of ischemia, intracerebral hemorrhage, or tumor. The patient presented the following postictal features: involuntary eye deviation to the right due to left-sided gaze palsy and disorientation in time with preserved responsiveness. Eye movements were normal three days later. We concluded that the patient suffered from new-onset epilepsy due to sequelae following the right frontotemporal subarachnoid hemorrhage, affecting the FEF with contralateral ictal gaze deviation, and postictal gaze palsy with ipsilateral eye deviation as an unusual Todd's phenomenon. Conclusion: Unusual manifestations of TP are uncommon but clinically highly relevant, as they can mimic stroke or epileptic status and are decisive in the diagnostic and therapeutic decision-making process. Though postictal gaze palsy has been reported associated with other deficits, this constitutes, to our knowledge, the first report of isolated gaze palsy as a form of TP. Further research into the underlying causes is needed. Ictal contralateral gaze and head deviation, and probably postictal ipsilateral gaze deviation if present, are very helpful for the lateralization of the seizure-onset zone.

中文翻译：

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凝视麻痹是托德现象的表现：病例报告和文献复习。

背景：尽管托德现象（TP）相对罕见，但作为中风模仿者，正确识别它对诊断和治疗具有重要意义。在这里，我们将一例孤立的凝视性麻痹描述为TP的表现，讨论周壁凝视异常作为涉及额叶视野（FEF）的侧向化体征，并提供叙述性文献综述。方法：我们审查了该病例的主要特征，并使用PubMed对TP和凝视麻痹进行了结构化文献检索。我们将搜索限制为英语，西班牙语，法语和德语的出版物。案例介绍：一名有右额颞下蛛网膜下腔出血史的71岁男性在首次无端发作双侧强直性阵挛性癫痫发作，左侧出现眼动凝视偏斜后入院。颅骨成像未显示缺血，脑出血或肿瘤的迹象。该患者表现出以下姿势特征：由于左侧凝视麻痹而导致右眼不自主偏斜以及及时迷失方向并保留了反应能力。三天后眼球运动恢复正常。我们得出的结论是，患者因右额颞下蛛网膜下腔出血后遗症而遭受新发作的癫痫病，影响FEF并伴有对侧眼斜视，以及伴有同侧眼斜视的视线麻痹，这是一种罕见的托德现象。结论：TP的异常表现并不常见，但在临床上具有高度相关性，因为它们可以模仿中风或癫痫状态，并且在诊断和治疗决策过程中起决定性作用。尽管已经报道了邮政凝视性麻痹与其他缺陷有关，但据我们所知，这是首次将凝视性麻痹作为TP的形式报道。需要对根本原因进行进一步研究。局部对侧凝视和头部偏移，以及可能存在的局部同侧凝视偏移，对于癫痫发作区的侧向化非常有帮助。尽管已经报道了邮政凝视性麻痹与其他缺陷有关，但据我们所知，这是首次将凝视性麻痹作为TP的形式报道。需要对根本原因进行进一步研究。局部对侧凝视和头部偏移，以及可能存在的局部同侧凝视偏移，对于癫痫发作区的侧向化非常有帮助。尽管已经报道了邮政凝视性麻痹与其他缺陷有关，但据我们所知，这是首次将凝视性麻痹作为TP的形式报道。需要对根本原因进行进一步研究。局部对侧凝视和头部偏移，以及可能存在的局部同侧凝视偏移，对于癫痫发作区的侧向化非常有帮助。