Atypical Presentation of Antenatal Eclampsia

Abstract

Most women who develop eclampsia have preceding preeclampsia (proteinuria and hypertension). This is especially true for otherwise healthy nulliparous women. However, recently, there has been a paradigm shift in this philosophy. There is mounting evidence that preeclampsia can develop even in the absence of proteinuria and hypertension and that eclampsia itself may be the initial manifestation of hypertensive disorder during pregnancy. We report a rare case of a 24-year-old primigravida at 30 weeks of gestation who presented with new-onset generalised tonic-clonic seizures without prior hypertension or proteinuria in her antenatal records. A thorough workup revealed this presentation to be the initial feature of atypical eclampsia. She was managed appropriately and discharged with an excellent outcome. This experience highlights some of the difficulties in managing a case of atypical eclampsia, namely, erratic onset and an unpredictable course, all of which interfere with timely diagnosis and treatment and contribute to maternal and fetal morbidity and mortality.

Atypical eclampsia in a normotensive patient with altered mental status and severely elevated transaminases: Case report and review

“…The literature contains additional case reports of atypical eclampsia (Table 2) in which the seizures were refractory to standard medical management 16–18 or in which they developed prior to 20 weeks' gestational age, 19,20 in the late postpartum period, 21–25 in the absence of proteinuria, 16,22,24,25 or in the absence of elevated blood pressures 17,21,22,24–28 . Eclampsia infrequently occurs without pre‐existing or subsequent hypertension, and our report adds to the limited number of such cases in the literature.…”

“…found that hypertension was absent in 16% of cases in a series of 399 women with eclampsia. To our knowledge, there have been fewer than 25 reported cases since then of atypical eclampsia in persistently normotensive patients, 17,21,22,[24][25][26][27][28] with only one of these cases occurring in the United States. 24 Among these normotensive patients with atypical eclampsia, only one had a reported abnormal transaminase value, with a slightly elevated AST of 66 U/L and a normal ALT of 35 U/L.…”