Late Postpartum Eclampsia 16 Days after Delivery: Case Report with Clinical, Radiologic, and Pathophysiologic Correlations

Michael W. Felz, Daniel B. Barnes, Ramon E. Figueroa

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Postpartum eclampsia is a rare, frightening, and potentially tragic complication of hypertensive pregnancies, usually developing within 48 hours of delivery. Seizures occurring days to weeks after parturition are exceedingly uncommon and require rapid, precise clinical evaluation by multiple specialists. Methods: A case presentation of delayed postpartum eclampsia illustrates unique features of the syndrome. Extensive review of the literature highlights pathogenesis, controversies, and dilemmas surrounding this enigmatic hypertensive disorder. Results and Conclusions: A 39-year-old hypertensive patient had an uneventful full-term delivery by her family physician only to develop headache, double vision, and recurrent tonic-clonic seizures 16 days later. Initial evaluation showed severe hypertension, diplopia, hyperreflexia, proteinuria, and hyperuricemia. She was given a magnesium sulfate infusion. Magnetic resonance imaging (MRI) documented asymmetric ischemic foci within gray matter in the distribution of the posterior cerebral arteries. All symptoms, signs, and abnormal laboratory values resolved within 4 days. A follow-up MRI showed complete resolution of all cytotoxic cortical lesions. Based on human autopsy data, radiologic investigations, and animal studies, eclampsia is believed to result from explosive vasospasm, endothelial dysfunction, and cytotoxic edema of cerebral cortex. This central nervous system vasculopathy is most prominent in the posterior cerebral vasculature and is often rapidly reversible. Difficulties in differential diagnosis, typical findings on neuroimaging, and urgent management strategies are discussed. The time limit for postpartum eclampsia probably should be lengthened to 4 weeks, as indicated by our case and other clinical series.

Original languageEnglish (US)
Pages (from-to)39-46
Number of pages8
JournalJournal of the American Board of Family Practice
Volume13
Issue number1
StatePublished - Jan 1 2000

Fingerprint

Eclampsia
Postpartum Period
Diplopia
Seizures
Magnetic Resonance Imaging
Posterior Cerebral Artery
Abnormal Reflexes
Magnesium Sulfate
Hyperuricemia
Pregnancy Complications
Family Physicians
Proteinuria
Neuroimaging
Cerebral Cortex
Signs and Symptoms
Headache
Autopsy
Edema
Differential Diagnosis
Central Nervous System

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Late Postpartum Eclampsia 16 Days after Delivery : Case Report with Clinical, Radiologic, and Pathophysiologic Correlations. / Felz, Michael W.; Barnes, Daniel B.; Figueroa, Ramon E.

In: Journal of the American Board of Family Practice, Vol. 13, No. 1, 01.01.2000, p. 39-46.

Research output: Contribution to journalArticle

@article{a2dd46cbc6ed41b6bec26a99b4fa0428,
title = "Late Postpartum Eclampsia 16 Days after Delivery: Case Report with Clinical, Radiologic, and Pathophysiologic Correlations",
abstract = "Background: Postpartum eclampsia is a rare, frightening, and potentially tragic complication of hypertensive pregnancies, usually developing within 48 hours of delivery. Seizures occurring days to weeks after parturition are exceedingly uncommon and require rapid, precise clinical evaluation by multiple specialists. Methods: A case presentation of delayed postpartum eclampsia illustrates unique features of the syndrome. Extensive review of the literature highlights pathogenesis, controversies, and dilemmas surrounding this enigmatic hypertensive disorder. Results and Conclusions: A 39-year-old hypertensive patient had an uneventful full-term delivery by her family physician only to develop headache, double vision, and recurrent tonic-clonic seizures 16 days later. Initial evaluation showed severe hypertension, diplopia, hyperreflexia, proteinuria, and hyperuricemia. She was given a magnesium sulfate infusion. Magnetic resonance imaging (MRI) documented asymmetric ischemic foci within gray matter in the distribution of the posterior cerebral arteries. All symptoms, signs, and abnormal laboratory values resolved within 4 days. A follow-up MRI showed complete resolution of all cytotoxic cortical lesions. Based on human autopsy data, radiologic investigations, and animal studies, eclampsia is believed to result from explosive vasospasm, endothelial dysfunction, and cytotoxic edema of cerebral cortex. This central nervous system vasculopathy is most prominent in the posterior cerebral vasculature and is often rapidly reversible. Difficulties in differential diagnosis, typical findings on neuroimaging, and urgent management strategies are discussed. The time limit for postpartum eclampsia probably should be lengthened to 4 weeks, as indicated by our case and other clinical series.",
author = "Felz, {Michael W.} and Barnes, {Daniel B.} and Figueroa, {Ramon E.}",
year = "2000",
month = "1",
day = "1",
language = "English (US)",
volume = "13",
pages = "39--46",
journal = "Journal of the American Board of Family Medicine",
issn = "1557-2625",
publisher = "American Board of Family Medicine",
number = "1",

}

TY - JOUR

T1 - Late Postpartum Eclampsia 16 Days after Delivery

T2 - Case Report with Clinical, Radiologic, and Pathophysiologic Correlations

AU - Felz, Michael W.

AU - Barnes, Daniel B.

AU - Figueroa, Ramon E.

PY - 2000/1/1

Y1 - 2000/1/1

N2 - Background: Postpartum eclampsia is a rare, frightening, and potentially tragic complication of hypertensive pregnancies, usually developing within 48 hours of delivery. Seizures occurring days to weeks after parturition are exceedingly uncommon and require rapid, precise clinical evaluation by multiple specialists. Methods: A case presentation of delayed postpartum eclampsia illustrates unique features of the syndrome. Extensive review of the literature highlights pathogenesis, controversies, and dilemmas surrounding this enigmatic hypertensive disorder. Results and Conclusions: A 39-year-old hypertensive patient had an uneventful full-term delivery by her family physician only to develop headache, double vision, and recurrent tonic-clonic seizures 16 days later. Initial evaluation showed severe hypertension, diplopia, hyperreflexia, proteinuria, and hyperuricemia. She was given a magnesium sulfate infusion. Magnetic resonance imaging (MRI) documented asymmetric ischemic foci within gray matter in the distribution of the posterior cerebral arteries. All symptoms, signs, and abnormal laboratory values resolved within 4 days. A follow-up MRI showed complete resolution of all cytotoxic cortical lesions. Based on human autopsy data, radiologic investigations, and animal studies, eclampsia is believed to result from explosive vasospasm, endothelial dysfunction, and cytotoxic edema of cerebral cortex. This central nervous system vasculopathy is most prominent in the posterior cerebral vasculature and is often rapidly reversible. Difficulties in differential diagnosis, typical findings on neuroimaging, and urgent management strategies are discussed. The time limit for postpartum eclampsia probably should be lengthened to 4 weeks, as indicated by our case and other clinical series.

AB - Background: Postpartum eclampsia is a rare, frightening, and potentially tragic complication of hypertensive pregnancies, usually developing within 48 hours of delivery. Seizures occurring days to weeks after parturition are exceedingly uncommon and require rapid, precise clinical evaluation by multiple specialists. Methods: A case presentation of delayed postpartum eclampsia illustrates unique features of the syndrome. Extensive review of the literature highlights pathogenesis, controversies, and dilemmas surrounding this enigmatic hypertensive disorder. Results and Conclusions: A 39-year-old hypertensive patient had an uneventful full-term delivery by her family physician only to develop headache, double vision, and recurrent tonic-clonic seizures 16 days later. Initial evaluation showed severe hypertension, diplopia, hyperreflexia, proteinuria, and hyperuricemia. She was given a magnesium sulfate infusion. Magnetic resonance imaging (MRI) documented asymmetric ischemic foci within gray matter in the distribution of the posterior cerebral arteries. All symptoms, signs, and abnormal laboratory values resolved within 4 days. A follow-up MRI showed complete resolution of all cytotoxic cortical lesions. Based on human autopsy data, radiologic investigations, and animal studies, eclampsia is believed to result from explosive vasospasm, endothelial dysfunction, and cytotoxic edema of cerebral cortex. This central nervous system vasculopathy is most prominent in the posterior cerebral vasculature and is often rapidly reversible. Difficulties in differential diagnosis, typical findings on neuroimaging, and urgent management strategies are discussed. The time limit for postpartum eclampsia probably should be lengthened to 4 weeks, as indicated by our case and other clinical series.

UR - http://www.scopus.com/inward/record.url?scp=0033628771&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033628771&partnerID=8YFLogxK

M3 - Article

C2 - 10682884

AN - SCOPUS:0033628771

VL - 13

SP - 39

EP - 46

JO - Journal of the American Board of Family Medicine

JF - Journal of the American Board of Family Medicine

SN - 1557-2625

IS - 1

ER -