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Research ArticleMedical Practice

Late Postpartum Eclampsia 16 Days after Delivery: Case Report With Clinical, Radiologic, and Pathophysiologic Correlations

Michael W Felz, Daniel B. Barnes and Ramon E. Figueroa
The Journal of the American Board of Family Practice January 2000, 13 (1) 39-46; DOI: https://doi.org/10.3122/jabfm.13.1.39
Michael W Felz
From the Department of Family Medicine (MWF, DBB) and the Department of Neuroradiology (REF), Medical College of Georgia, Augusta. Address reprint request to Michael W. Felz, MD, Department of Family Medicine, HB 4032, Medical College of Georgia, Augusta, GA 30912
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Daniel B. Barnes
From the Department of Family Medicine (MWF, DBB) and the Department of Neuroradiology (REF), Medical College of Georgia, Augusta. Address reprint request to Michael W. Felz, MD, Department of Family Medicine, HB 4032, Medical College of Georgia, Augusta, GA 30912
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Ramon E. Figueroa
From the Department of Family Medicine (MWF, DBB) and the Department of Neuroradiology (REF), Medical College of Georgia, Augusta. Address reprint request to Michael W. Felz, MD, Department of Family Medicine, HB 4032, Medical College of Georgia, Augusta, GA 30912
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Abstract

Background: Postpartum eclampsia is a rare, frightening, and potentially tragic complication of hypertensive pregnancies, usually developing within 48 hours of delivery. Seizures occurring days to weeks after parturition are exceedingly uncommon and require rapid, precise clinical evaluation by multiple specialists. .

Methods: A case presentation of delayed postpartum eclampsia illustrates unique features of the syndrome. Extensive review of the literature highlights pathogenesis, controversies, and dilemmas surrounding this enigmatic hypertensive disorder.

Results and Conclusions: A 39-year-old hypertensive patient had an uneventful full-term delivery by her family physician only to develop headache, double vision, and recurrent tonic-clonic seizures 16 days later. Initial evaluation showed severe hypertension, diplopia, hyperreflexia, proteinuria, and hyperuricemia. She was given a magnesium sulfate infusion. Magnetic resonance imaging (MRI) documented asymmetric ischemic foci within gray matter in the distribution of the posterior cerebral arteries. All symptoms, signs, and abnormal laboratory values resolved within 4 days. A follow-up MRI showed complete resolution of all cytotoxic cortical lesions. Based on human autopsy data, radiologic investigations, and animal studies, eclampsia is believed to result from explosive vasospasm, endothelial dysfunction, and cytotoxic edema of cerebral cortex. This central nervous system vasculopathy is most prominent in the posterior cerebral vasculature and is often rapidly reversible. Difficulties in differential diagnosis, typical findings on neuroimaging, and urgent management strategies are discussed. The time limit for postpartum eclampsia probably should be lengthened to 4 weeks, as indicated by our case and other clinical series.

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The Journal of the American Board of Family     Practice: 13 (1)
The Journal of the American Board of Family Practice
Vol. 13, Issue 1
1 Jan 2000
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Late Postpartum Eclampsia 16 Days after Delivery: Case Report With Clinical, Radiologic, and Pathophysiologic Correlations
Michael W Felz, Daniel B. Barnes, Ramon E. Figueroa
The Journal of the American Board of Family Practice Jan 2000, 13 (1) 39-46; DOI: 10.3122/jabfm.13.1.39

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Late Postpartum Eclampsia 16 Days after Delivery: Case Report With Clinical, Radiologic, and Pathophysiologic Correlations
Michael W Felz, Daniel B. Barnes, Ramon E. Figueroa
The Journal of the American Board of Family Practice Jan 2000, 13 (1) 39-46; DOI: 10.3122/jabfm.13.1.39
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