Late onset postpartum eclampsia: a rare and difficult diagnosis

Late postpartum eclampsia without the classical pre-eclamptic signs oedema, proteinuria and hypertension is a rarely noticed complication of pregnancy. In three patients eclampsia started no earlier than 6, 8 and 11 days postpartum. Seizures were preceded by headache, vomiting, visual disturbance or impaired level of consciousness. One patient suffered a series of seizures making neurointensive care necessary. In another patient the clinical course was complicated by an additional Guillain-Barré syndrome. Aside from the typical parieto-occipital lesions brain MRI showed cerebellar hyperintensities on T2 weighted sequences as well as abnormalities on diffusion weighted images in one patient. In all patients neurological deficits and MRI findings were reversible.