"BABY, BABY I'VE GOT HEADACHE"

A 26-year-old woman with no prior medical history presented post-partum with altered mental status. She had no complications during pregnancy and had a spontaneous vaginal delivery at term one week prior. On post-partum day five, she began complaining of headaches, initially responsive to ibuprofen but eventually worsened with no relief. On the evening of admission, her boyfriend noted strange behavior and movements consistent with a tonic-clonic seizure. On the way to the hospital, she had two more similar seizures witnessed by emergency medical serevices (EMS). EMS reported her blood pressures in route to be 200/100s. She was given 5 mg of magnesium by EMS due to concern for postpartum eclampsia. Upon arrival at the emergency room, she was somnolent but arousable although unable to answer any questions. She was mildly tachycardic at 106 beats per minute and had a temperature of 38.2°C. Her blood pressure was elevated at 165/95 mm Hg. On exam, dried blood was noted on her lips and her tongue was swollen. On auscultation, she was tachycardic with clear lung sounds. Her abdomen was soft and non-tender and there was no vaginal bleeding or other discharge. Laboratory values revealed a sodium of 142, potassium of 3.3, chloride of 110, bicarbonate of 16, creatinine of 1.1, magnesium of 3.9, and white blood cell count of 12.3 x103/mm3 with 88% neutrophils and no bands. A toxicology panel was negative for opiates, benzodiazepines, or other illicit drugs. Urine was remarkable for large blood, 448 red blood cells, protein, moderate leukocyte esterase, and 73 white blood cells. Chest x-ray and CT scan of the head were both normal. She was admitted to the medical intensive care unit for close monitoring, neurological checks, and continued magnesium administration. By hospital day two, her mental status had improved significantly.