Delayed peripartum vasculopathy: cerebral eclampsia revisited.

Over a 2-year period, we treated 4 postpartum patients with acute neurologic problems appearing 4 to 9 days after delivery. Three patients either had no proteinuria or edema and therefore did not meet all accepted clinical criteria for the diagnosis of eclampsia. Magnetic resonance imaging (MRI) of the brain in all patients demonstrated high-signal foci most prominent in the parieto-occipital regions and the subcortical white matter. Cerebral angiogram in 2 patients revealed diffuse vasospasm. In 3 patients, MRI abnormalities resolved. MRI and angiographic abnormalities in our patients are identical to those of patients meeting accepted criteria for eclampsia. Our experience suggests that the current criteria for the diagnosis of eclampsia are too stringent, both in terms of clinical picture and days postpartum to cerebral manifestations.