A case of delayed postpartum eclampsia

Background. Delayed postpartum eclampsia is the occurrence of one or more seizures from 48 h to 6 weeks after delivery in a woman with signs and/or symptoms of preeclampsia. We describe an atypical case of delayed eclampsia.
Case presentation. Data were collected from hospital medical records and telephone interview.
A 39-year-old woman was admitted to the Emergency Depart­ment, University Hospital of Careggi, Florence, with head­ache not responsive to pharmacologic treatment, blurred vi­sion and new onset hypertension ten days after delivery.
Pregnancy had been complicated by gestational diabetes and she had performed a planned caesarean section for previous uterine surgery.
After her arrival she had seizures. Antihypertensive and antie­pileptic drugs were administrated and blood tests, computed tomography (CT), electrocardiogram, magnetic resonance im­aging (MRI), electroencephalography and supra-aortic trunk ultrasound were performed. Blood tests showed no abnor­mality. CT suggested the occurrence of an adrenal mass suspi­cious for pheochromocytoma and MRI demonstrated PRESS (Posterior Reversible Encephalopathy Syndrome).
After 20 days of hospitalization in stroke unit, the patient was discharged with antihypertensive and anticonvulsant therapy. Excluding other differential diagnoses, in particular pheochromocytoma, postpartum eclampsia was confirmed also at 6 months. At 5 years follow-up, the patient shows no neurological sequelae and no cardiovascular, renal or hepatic impairment.
Conclusions. Eclampsia should be suspected in all cases of seizures up to 6 weeks after delivery. Prompt and proper dif­ferential diagnosis, combined with an appropriate treatment, can prevent adverse outcomes. Accurate counselling on the risks associated with future pregnancies and on cardiovascu­lar long-life risks is mandatory.