Diagnostic Dilemma Regarding Postpartum Seizure in the Setting of Preeclampsia

Abstract

This case demonstrates a diagnostic dilemma regarding the management of seizures in the postnatal setting. It seeks to highlight the importance of a thorough exploration of history and risk factors for females presenting with seizures in the postpartum period to ensure appropriate treatment and workup. Preeclampsia (PET) is a hypertensive disorder of pregnancy affecting 2%-8% of pregnancies worldwide. Less than 1% of females with preeclampsia experience eclamptic seizures. However, they are associated with significant mortality and morbidity. The majority of these seizures occur in the third trimester with 80% occurring intrapartum or within 48 hours of delivery. Warning symptoms such as headache, visual disturbances, or epigastric pain are not always present. Eclamptic seizures after the first week postpartum are very rare. Seizures, in general, are triggered by many other organic and nonorganic causes, one of which is neurocysticercosis (NCC) most often caused by Taenia solium. Neurocysticercosis is endemic in sub-Saharan Africa and Southeast Asia. In endemic areas, it accounts for approximately 30% of the cases of adult-onset epilepsy, second only to tuberculosis (TB). This is a case of a 40-year-old para 1 female who experienced a postpartum seizure in the setting of preeclampsia diagnosed in the intrapartum period. She successfully underwent standard treatment for the management of eclampsia. Further workup demonstrated brain lesions suspicious for neurocysticercosis, ultimately prompting diagnosis and appropriate neurological management. Neurocysticercosis is a commonly overlooked etiology in the Australian peripartum healthcare setting. It must be included in the differential diagnosis of patients with new-onset seizures who may be from endemic areas. The diagnosis of neurocysticercosis is based on a combination of clinical findings, exposure history, imaging, and serology.