Brainstem Hemorrhage Following Eclampsia and HELLP Syndrome: A Case Report of an Unusual Neuro-Obstetric Complication

Hypertensive disorders of pregnancy can cause severe neurological complications, including intracerebral hemorrhage. We report a peripartum case of eclampsia complicated by complete hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome and a large posterior fossa brainstem hemorrhage with prolonged disorder of consciousness requiring prolonged intensive care and rehabilitation. Initial neuroimaging confirmed the hemorrhage with posterior fossa involvement and mass effect, and the clinical course was complicated by multiorgan dysfunction, including severe acute kidney injury requiring renal replacement therapy. This case emphasizes that persistent or unexplained coma after eclampsia should not be attributed solely to a post-ictal state or sedative effects and should prompt urgent neuroimaging to exclude catastrophic intracranial hemorrhage.