title: Late Postpartum Eclampsia with Postpartum Angiopathy: An Uncommon Diagnosis in the Emergency Department.
abstract: BACKGROUND
  Late postpartum eclampsia is defined as occurrence of eclampsia >48 h after delivery and is a rare clinical entity. The delayed onset and nonspecific symptoms at presentation make this entity a challenge to diagnose in patients presenting to the emergency department (ED); however, early recognition and timely interventions are the keys to reducing morbidity and mortality in patients with late postpartum eclampsia.
  
  
  METHODS
  A 28-year-old woman presented to our ED with a chief complaint of headache of 4 days duration, 8 days after an uncomplicated, normal vaginal delivery. Her past medical history was unremarkable and her entire pregnancy was without medical incident. The patient's examination was within normal limits other than a blood pressure of 152/111 mm Hg and pulse of 54 beats/min. Given her undifferentiated headache and the possibility of preeclampsia, the patient was treated with magnesium sulfate, which was subsequently stopped due to worsening bradycardia. Hydralazine was administered for blood pressure control. Three hours after the magnesium was stopped, the patient reported blurry vision, which was immediately followed by a generalized tonic-clonic seizure. After the seizure, lorazepam was given for control of seizures, and the patient was admitted to the medical intensive care unit. The patient was transferred to the postpartum floor 6 days later in stable condition and without any further seizure activity. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients with late postpartum eclampsia are infrequently encountered in the ED due to the rarity of this condition. Increased awareness of this entity among emergency physicians will lead to early interventions, which are crucial in decreasing morbidity and mortality in these patients.
authors.affiliation: Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York.
authors.forename: Deepika
authors.initials: D
authors.lastname: Garg
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York.
authors.forename: Brad
authors.initials: B
authors.lastname: Rahaman
authors.affiliation: Department of Radiology, Maimonides Medical Center, Brooklyn, New York.
authors.forename: Evan G
authors.initials: EG
authors.lastname: Stein
authors.affiliation: Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York.
authors.forename: Eitan
authors.initials: E
authors.lastname: Dickman
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004461:Eclampsia / Q000175:diagnosis* / Q000188:drug therapy; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006830:Hydralazine / Q000627:therapeutic use; D008140:Lorazepam / Q000627:therapeutic use; D008278:Magnesium Sulfate / Q000627:therapeutic use; D011247:Pregnancy; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000188:drug therapy; D014652:Vascular Diseases / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000927:Anticonvulsants; D000959:Antihypertensive Agents; D006830:Hydralazine; D008278:Magnesium Sulfate; D008140:Lorazepam
keywords: headache; late postpartum eclampsia; seizure