Magnetic resonance imaging in puerperal seizures: Postpartum eclampsia or cerebral venous thrombosis?

Abstract We reviewed cranial magnetic resonance imaging (MRI) studies in three women with puerperal seizures. One patient had eclampsia and had extensive parasagittal abnormalities on MRI, but she had a normal neurologic examination and recovered without sequelae. The other patients presented with postpartum seizures but were not eclamptic. Both of these women also had parasagittal abnormalities on MRI, which were less severe than the patient with eclampsia. However, both of these patients had neurologic sequelae. One woman had persistent headaches; the other had persistent seizures. In both of these women, EEG showed persistent epileptiform abnormalities. Convalescent MRI was normal in all three patients. Contrary to recent reports, we suggest that cranial MRI in women with puerperal seizures is not specific for eclampsia and does not necessarily predict the clinical course.