Eclampsia differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Seizures during pregnancy that are unrelated to Preeclampsia need to be distinguished from Eclampsia.

Differentiating Eclampsia from other Diseases

Eclampsia must be differentiated from other diseases that can cause seizures during pregnancy. The differentiation can be done by obtaining a proper history, physical examination, diagnostic tests, or imaging. Such disorders include:

• Acute exacerbation of systemic lupus erythematous
• Adrenal Insufficiency or Acute Adrenal crisis
• Aneurysm of the brain
• Brain tumor
• Cerebellar Haemorrhage
• Disseminated herpes simplex
• Disseminated sepsis syndromes
• Drug Overdose syndromes
• Drug Withdrawal syndromes
• Encephalitis
• Fatty liver of pregnancy
• Hemolytic uremic syndrome
• Hypertensive encephalopathy
• Hypoglycemia
• Medication- or drug-related seizures
• Meningitis
• Posterior reversible encephalopathy syndrome (PRES)
• Primary Hyperaldosteronism
• Seizure disorders and Epilepsy
• Stroke (Hemorrhagic or Ischemic)
• Thrombotic thrombocytopenic purpura

Usually, the presence of the signs of severe preeclampsia that precede and accompany eclampsia facilitates the diagnosis.

Differential Diagnosis	Similar Features	Differentiating Features
Acute exacerbation of SLE	Lupus flares can present with proteinuria, hypertension, deterioration in kidney function, thrombocytopenia and seizure also observed in eclampsia.	On urine examination, cellular casts and proteinuria can be found in SLE while only proteinuria is seen in Eclampsia. SLE is associated with decreasing levels of complement and incresing titre of anti-dsDNA. Also, a history of previous SLE and onset of symptoms before 20 weeks points towards lupus and a renal biopsy can help confirm the diagnosis although it is genereally not recommended during pregnancy.
Acute adrenal insufficiency	Adrenal insufficiency can present with fatigue, nausea, vomiting, increased heart rate, increased respiratory rate, loss of appetite, headache, abdominal pain, confusion, loss of consciousness, abnormal body movements, or coma, also seen in eclampsia.	Adrenal insufficiency will present with hypotension, whereas eclampsia is associated with high blood pressure. Also, AI patients may have a history of chronic use of steroids for diseases such as asthma, rheumatoid arthritis, etc. Patients may present with symptoms only in the postpartum period as during pregnancy they may acquire cortisol transplacentally from the fetus. Diagnostic tests show decreased morning basal serum cortisol, decreased salivary free cortisol, not seen in eclampsia. Further cosyntropin test and basal ACTH levels can be done. Imaging (MRI without gadolinium administration should be done in pregnant women) may show a pituitary tumor or a cranial SOL.
Differential 3	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 4	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 5	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].