Post partum seizures without hypertension: a case report of neurocysticercosis mimicking eclampsia

Abstract

Postpartum seizures are most commonly attributed to eclampsia; however, alternative etiologies must be considered when classical features such as hypertension and proteinuria are absent. Neurocysticercosis (NCC) is the leading cause of acquired epilepsy in endemic regions, including India, accounting for nearly 30% of epilepsy cases in such populations. We report a case of a 23-year-old primigravida at 33 weeks and 6 days of gestation who underwent emergency lower segment cesarean section for placenta previa with active vaginal bleeding. The postoperative period was uneventful initially. On postoperative day 3, she developed a focal seizure without hypertension or proteinuria, for which magnesium sulfate was empirically initiated for suspected atypical eclampsia. A recurrent focal seizure with preserved awareness occurred on postoperative day 5, prompting neurology consultation. Magnetic resonance imaging of the brain revealed multiple ring-enhancing lesions consistent with NCC. The patient was managed with antiepileptic drugs, anti-parasitic therapy, and corticosteroids, with clinical improvement and no further seizure episodes during hospital stay. This case underscores the importance of considering NCC in the differential diagnosis of postpartum seizures in endemic regions, particularly when classical eclamptic features are absent, and highlights the indispensable role of early neuroimaging in guiding management.