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Nephrotic syndrome
1%
1/67
Eclampsia
91%
61/67
Toxoplasmosis
0%
0/67
HELLP syndrome
Pre-eclampsia
4%
3/67
Select Answer to see Preferred Response
The most likely diagnosis would be eclampsia. Eclampsia is the presence of pre-eclampsia (hypertension and proteinuria) plus seizures. Eclampsia is a life-threatening complication of pregnancy. Hypertension, proteinuria, and seizures all must be present for the diagnosis to be made. The seizures of eclampsia are not attributable to pre-existing brain disorders or seizure activity. Risk factors include first pregnancies, pre-existing vascular and thrombophilic diseases, in addition to those that have had a previous diagnosis of pre-eclampsia or eclampsia. The seizures of eclampsia are managed with magnesium sulfate, which helps to prevent convulsions. Fogleman discusses eclampsia and medications used to treat the underlying pathology. Magnesium sulfate is considered the first-line treatment in prevention of eclamptic seizures. Eclampsia is a severe complication of pregnancy that is distinguished from pre-eclampsia by the presence of seizures. Magnesium sulfate reduces the risk of eclampsia by more than 50%. Hart et al. report on seizures during pregnancy. Although seizures complicate <1% of gestations, they are associated with higher rates of adverse maternal and perinatal outcomes. Although the differential diagnosis is broad, it is important to remember three main contributors: epilepsy, eclampsia, and stroke. A multidisciplinary approach with specialties such as neurology is of utmost importance. Figure A is a photograph showing edematous lower extremities. Incorrect Answers: Answer 1: Nephrotic syndrome encompasses the constellation of symptoms including hypertension, proteinuria, and edema. One would not expect to see seizures with nephrotic syndrome. Answer 3: Toxoplasmosis typically presents with flu-like symptoms including lymphadenopathy and myalgias. Toxoplasma gondii is the "T" of "TORCH" infections in addition to Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections. These are some of the most common infections associated with congenital anomalies. Answer 4: HELLP syndrome presents with Hemolysis, Elevated LFTs, and Low Platelets. Answer 5: Pre-eclampsia will present with hypertension and proteinuria alone. There should be no evidence of seizures.
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