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Case records of the Massachusetts General Hospital. Case 8-2009. A 36-year-old woman with headache, hypertension, and seizure 2 weeks post partum.

Dr. W. Taylor Kimberly: A 36-year-old woman was admitted to the hospital because of headaches, hypertension, and seizures. Nineteen days before the current admission, she delivered healthy twins at 35.6 weeks of gestation by cesarean section (for breech presentation) at another hospital. She was discharged on the fifth day. Nine days before the current admission, she began to have intermittent, throbbing, bifrontal headaches, and 2 days later she saw her gynecologist. She rated the pain as 8 (on a scale of 0 to 10, with 10 being the most severe pain). The blood pressure was 150/72 mm Hg. She was referred to an internist the same day, but she did not see the internist because the headache resolved while she was in the waiting room, and she returned home. Headache recurred that evening, and she went to the emergency department of a second hospital, where the blood pressure was 190/80 mm Hg. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain and the results of laboratory tests were reportedly normal. Oxycodone–acetaminophen was given for pain; the blood pressure decreased to 168/70 mm Hg, and she was sent home. Four days before admission, the patient saw the internist. She reported that the headaches were sudden in onset and were usually worse in the early morning, when they awakened her from sleep, and in the late afternoon. She described her current headache as dull and rated the severity of the pain as 2 out of 10. The blood pressure was 142/78 mm Hg; trace peripheral edema was present. The remainder of the examination was normal. Furosemide and potassium chloride were prescribed. Two days before admission, a severe headache (10 out of 10 in severity) occurred, with nausea and photophobia. The patient returned to the emergency room of the second hospital; the blood pressure was 204/96 mm Hg. The hematocrit was 34.7%; the results of the remainder of the complete blood count were normal, as were the results of other laboratory tests, including measurements of serum electrolytes, magnesium, calcium, and phosphorus and tests of renal and liver function. A urinalysis revealed that the specific gravity was 1.020, the pH 6.0, and the Case 8-2009: A 36-Year-Old Woman with Headache, Hypertension, and Seizure 2 Weeks Post Partum