Late Seizures in Postpartum Women After Cesarean Section: Differential Diagnosis Between Postpartum Eclampsia and Post-dural Puncture Eclampsia

Postpartum eclampsia is an uncommon but potentially life-threatening complication that can occur up to six weeks after delivery, even in women without prior hypertension. Post-dural puncture headache (PDPH), a frequent adverse effect of spinal anesthesia, typically presents as a postural headache and, in rare cases, may progress to seizures. The clinical overlap between these two conditions poses a significant diagnostic challenge. We report the case of a 25-year-old woman who underwent a cesarean section under spinal anesthesia and developed a headache immediately postpartum, which worsened on day four with generalized tonic-clonic seizures. Cranial CT and CSF analysis were unremarkable. During her intensive care stay, she experienced a hypertensive episode, prompting initiation of magnesium sulfate, levetiracetam, and antihypertensive therapy. Clinical evolution favored the diagnosis of late postpartum eclampsia, despite initial features suggestive of PDPH. Differentiating postpartum eclampsia from PDPH is complex, as both may present with headache and seizures. Hypertension in eclampsia can be intermittent, and proteinuria is not always present, making early clinical suspicion and magnesium sulfate administration critical. PDPH, usually benign, can rarely lead to seizures due to CSF hypotension. Although rare, the coexistence of both conditions cannot be excluded. This case underscores the importance of vigilant postpartum monitoring and prompt evaluation of severe headaches with neurological symptoms. Early recognition and a multidisciplinary approach are essential to minimize complications and ensure maternal safety.