Postpartum Cerebral Venous Thrombosis Complicating Eclampsia: A Case Report from an Obstetric Critical Care Unit in Toamasina, Madagascar

Background: Cerebral venous thrombosis (CVT) is a rare but potentially fatal neurological emergency that can complicate pregnancy and the puerperium. Hypertensive disorders of pregnancy, particularly eclampsia and HELLP syndrome (Haemolysis, Elevated Liver enzymes, and Low Platelet count), increase the risk of thrombosis. Early recognition and intensive care management are essential to prevent permanent neurological sequelae, especially in low-resource settings. Case report: We report the case of a 29-year-old multiparous woman admitted to the intensive care unit of the Centre Hospitalier Universitaire Analankininina Toamasina (CHUAT), Madagascar, for an acute disturbance of consciousness occurring two days after an emergency caesarean section performed for eclampsia. The patient developed repeated generalised seizures in an afebrile context. On admission, she presented with a Glasgow Coma Scale score of 7/15, severe hypertension (190/150 mmHg), and left-sided hemiplegia. Laboratory investigations revealed features of HELLP syndrome with acute kidney injury. Brain computed tomography showed biparietal and frontal hypodense lesions consistent with venous infarction. Anticoagulation was initiated after correction of coagulopathy and exclusion of haemorrhage. The patient improved gradually and was discharged after 23 days with residual left-sided weakness. Discussion: This case highlights the diagnostic and therapeutic challenges of managing postpartum CVT in low-resource obstetric intensive care settings. The combination of eclampsia, HELLP syndrome, and CVT is rare but severe, reflecting overlapping mechanisms of endothelial dysfunction, hypercoagulability, and microangiopathy. Access to advanced imaging such as magnetic resonance venography is often limited in low-income countries, delaying diagnosis and anticoagulation. Anticoagulation remains the mainstay of treatment once haemorrhage is excluded, complemented by seizure control and supportive critical care. Conclusion: Postpartum CVT should be suspected in any woman with seizures or altered consciousness after delivery, especially in the context of hypertensive disorders. Early neuroimaging, judicious anticoagulation, and multidisciplinary critical care are essential to improving maternal prognosis in resource-limited environments.