Pseudotoxemia: new onset psychogenic seizure in third trimester pregnancy

Eclampsia, or toxemia of pregnancy, is a disorder of pregnancy characterized by seizures associated with hypertension, edema, and proteinuria. Toxemia carries significant maternal and fetal morbidity and mortality. Psychogenic seizures are defined as events that clinically resemble epileptic seizures but are not accompanied by abnormal electrical activity of the cerebral cortex. We report the case of a third trimester pregnant patient who presented with new onset convulsive activity that was associated with peripheral edema, intermittent hypertension, and proteinuria. The initial impression of the treating physicians--emergency medicine, obstetrical, and neurology--was toxemia of pregnancy. After further review and the application of numerous procedures and therapies with potential risk, the diagnosis of psychogenic seizure was made.