Late onset postpartum eclampsia without pre-eclamptic prodromi: clinical and neuroradiological presentation in two patients

In two patients eclampsia started 9 days postpartum Headache and visual dis turbances preceded seizures but none of the classic pre-eclamptic signs oed ema, proteinuria, and hypertension were present until shortly before seizur e onset. Brain herniation (patient 1) and status epilepticus (patient 2) ne cessitated neurointensive care management. Brain MRI initially showed only frontal sulcal effacement in one patient but later showed white matter hype rintensities on T2 weighted images and a previously undescribed pattern of cortical-subcortical postgadolinium enhancement on T1 weighted images in bo th. Neurological deficits and MRI findings were reversed with therapy in bo th patients. It is concluded that late postpartum eclampsia can manifest wi thout classic prodromi and that characteristic MRI findings may lag behind clinical manifestation.