An Unusual Trio: Eclampsia, Posterior Reversible Encephalopathy, and Takotsubo Cardiomyopathy in a Twin Pregnancy

Abstract Background: Eclampsia remains a leading cause of maternal morbidity and mortality worldwide. The concurrent occurrence of posterior reversible encephalopathy syndrome (PRES) and Takotsubo cardiomyopathy in eclamptic patients represents an extremely rare but life-threatening combination requiring immediate multidisciplinary intervention. Case Presentation: We report a 31-year-old primigravida at 36 weeks and 4 days of twin gestation, conceived through intracytoplasmic sperm injection (ICSI), who presented with antepartum eclampsia complicated by PRES and Takotsubo cardiomyopathy. The patient had multiple comorbidities including gestational diabetes mellitus, hypothyroidism, and hepatitis B surface antigen positivity. She presented with generalized tonic-clonic seizures, severe hypertension (200/100 mmHg), and respiratory distress with oxygen saturation of 80% on room air. Emergency cesarean section was performed, delivering two viable late-preterm infants. Postoperative investigations revealed Takotsubo cardiomyopathy with ejection fraction of 40% and MRI findings consistent with PRES. Management and Outcome: The patient received immediate stabilization with anticonvulsants, antihypertensives, mechanical ventilation, and targeted cardiac therapy. Multidisciplinary care involving obstetrics, cardiology, anesthesiology, and intensive care teams resulted in complete maternal recovery by postoperative day 5, with improving cardiac function and neurological status. Conclusion: This case highlights the importance of recognizing atypical complications in eclampsia and emphasizes the need for prompt multidisciplinary management in tertiary care centers to optimize maternal and neonatal outcomes in complex obstetric emergencies.