A 24-year-old woman, 4 days after an uncomplicated vaginal delivery at term, presents with a generalised tonic-clonic seizure. She had a normal blood pressure throughout pregnancy. On arrival her BP is 168/112 mmHg and urinalysis shows 2+ proteinuria. Head CT is normal. What is the most likely diagnosis?

• A Posterior circulation ischaemic stroke
• B Intracranial venous sinus thrombosis
• C Idiopathic epilepsy
• D Postpartum eclampsia ✓

Explanation

Eclampsia is defined by seizures in a pre-eclamptic patient, and importantly it can occur for the first time in the postpartum period even when antenatal blood pressures were normal. Late postpartum eclampsia is recognised up to 4 weeks after delivery, so a seizure with significant hypertension and proteinuria on day 4 is eclampsia until proven otherwise. Venous sinus thrombosis is a real postpartum mimic but typically presents with headache and focal deficits over days, and a normal CT does not exclude eclampsia, which needs no imaging to diagnose.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.