[237-POS]: Postpartum eclampsia – A late presentation to keep in mind

Objectives Presentation of two cases of late postpartum eclampsia that took place at our hospital, one month apart. Eclampsia is defined as generalized seizures, in the setting of preeclampsia, without other neurologic conditions. With an incidence of 1:2.000 deliveries in developed countries, it occurs in 2% of women with severe preeclampsia and in 0.5% of those with non-severe preeclampsia. Although it may occur from gestation to puerperium, it is estimated that only 5–17% of cases take place after 48 h postpartum. While eclampsia is a clinical diagnosis, most cases present with reversible posterior leukoencephalopathy syndrome (RPLS) findings on MRI. Methods Review of literature and consultation of clinical files. Results CASE 1 – A 28-year-old female, G2P0, underwent cesarean delivery, at 38 weeks’ gestation, in the setting of preeclampsia and abnormal nonstress test. On day 6 postpartum, she experienced sudden frontooccipital headache, after which she had three generalized tonic–clonic seizures. On admission, she was postictal and hypertensive (170/120 mmHg), proteinuria 4+, normal CT scan and EEG. MRI revealed lesions compatible with PRLS. She was admitted to the ICU and treated with magnesium sulfate, valproate and antihypertensive medication, with no further seizures and gradual normalization of blood pressure. CASE 2 – A 31-year-old female, G5P3, with gestational hypertension, underwent vaginal delivery at 40 weeks’ gestation. Since day 2 postpartum she complained of a mild headache. On day 4 she developed blurred vision followed by generalized tonic–clonic seizure. At admission to the ICU, BP was 168/110 mmHg. CT and EEG were normal. MRI revealed RPLS. She underwent therapy with magnesium sulfate, valproate and antihypertensive therapy, with no additional seizures and stabilization of blood pressure. Conclusions Prompt exclusion of other causes of seizures, especially in late presentations, combined with early diagnosis and treatment, are central to avoid morbidity and mortality associated with eclampsia. Disclosures S. Nascimento: None. R. Gomes: None. T. Matos: None. I. Santos: None. F. Matos: None.