Eclampsia differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Navneet Kaur M.B.,B.S.


Seizures during pregnancy that are unrelated to Preeclampsia need to be distinguished from Eclampsia. This is essential to recognize the correct cause and provide the targeted treatment necessary in a timely manner.

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:

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.[1] Patients may present with symptoms only in the postpartum period as during pregnancy they may acquire cortisol transplacentally from the fetus.[2] 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.
Brain tumor(s)
  • Brain tumor often presents with signs of raised Intracranial pressure, such as headache, nausea, vomiting and seizures, also seen in eclampsia. Commom tumors that can be found are meningiomas[3], pituitary tumors, gliomas, etc.
  • Presence of past history of convulsions and absence of hypertension and proteinuria points towards cerebral pathology. Brain tumour may present with partial or localized seizures rather than GTCS and can have localized symptoms, such as visual disturbances in pituitary adenomas, localized sensory or motor changes, etc which could differentiate it from eclampsia. Also, brain imaging such as MRI can help establish the diagnosis.
Intracranial Haemorrhage/ Ruptured Brain Aneurysm
  • On physical exam, history and diagnostic test, ICH demonstrates headache, nausea and vomiting, vision abnormalities(such as blurring, scotomas, diminished vision), seizures, loss of consciousness also observed in Eclampsia.
  • The headache in ICH is often described as the worst headache of life. Presence of symptoms such as stiffness of neck, sensitivity to light, unilateral drooping of eyelid, unilateral symptoms of stroke(sensory or motor weakness), and absence of proteinuria, oliguria, edema, gestational hypertension differentiates its from Eclampsia. Neuroimaging (CT or MRI brain) will show AV malformation, ruptured blood vessel, blood in the subarachnoid space that distinguish it from Eclampsia.
Disseminated herpes simplex/ Herpes Simplex Encephalitis(HSE)
  • On physical exam and history Herpes Simplex Encephalitis(HSE) may present with Headache, Seizures( seen in 50% of cases [4]), vision abnormalities, confusion, hyperactivity also observed in eclampsia.
Drug overdose/Drug Intoxication
  • Careful history and past records will indicate if the patient is taking any recreational or prescriptional medication respectively that could lead to overdose. Other symptoms of preeclampsia like proteinuria, edema are generally absent. Urine drug screening and Blood screening will confirm the diagnosis.
Drug Withdral Syndromes
  • Encephalitis, inflammation of the brain, is most often caused by viral infection [6] , presents with seizures in 2-67% of cases [4], and headache also seen in eclampsia.
Acute Fatty Liver of Pregnancy (AFLP)
  • On history and physical exam AFLP demonstrates nausea and vomiting (seen in 50-60%), abdominal pain (50-60%), edema, mental status changes (altered sensorium, confusion, disorientation, psychosis, restlessness, seizures or coma) (60–80%), tachycardia (50%) also seen in eclampsia. [7]


  1. A. Chrisoulidou, C. Williamson, M. De Swiet, Assessment of adrenocortical function in women taking exogenous glucocorticoids during pregnancy. J. Obstet. Gynaecol. 23(6), 643–644 (2003)
  2. Drucker D, Shumak S, Angel A. Schmidt's syndrome presenting with intrauterine growth retardation and postpartum addisonian crisis. Am J Obstet Gynecol. 1984 May 15;149(2):229-30. doi: 10.1016/0002-9378(84)90206-0. PMID: 6720805.
  3. Hala M. Goma (April 10th 2013). Management of Brain Tumor in Pregnancy — An Anesthesia Window, Clinical Management and Evolving Novel Therapeutic Strategies for Patients with Brain Tumors, Terry Lichtor, IntechOpen, DOI: 10.5772/54250. Available from:
  4. 4.0 4.1 Misra UK, Tan CT, Kalita J (2008). "Viral encephalitis and epilepsy". Epilepsia. 49 Suppl 6: 13–8. doi:10.1111/j.1528-1167.2008.01751.x. PMID 18754956.
  5. Chen HY, Albertson TE, Olson KR (2016). "Treatment of drug-induced seizures". Br J Clin Pharmacol. 81 (3): 412–9. doi:10.1111/bcp.12720. PMC 4767205. PMID 26174744.
  6. Michael BD, Solomon T (2012). "Seizures and encephalitis: clinical features, management, and potential pathophysiologic mechanisms". Epilepsia. 53 Suppl 4: 63–71. doi:10.1111/j.1528-1167.2012.03615.x. PMID 22946723.
  7. 7.0 7.1 7.2 7.3 Ko H, Yoshida EM (2006). "Acute fatty liver of pregnancy". Can J Gastroenterol. 20 (1): 25–30. doi:10.1155/2006/638131. PMC 2538964. PMID 16432556.

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