Differential Diagnosis for 26 YOF 1 Week Postpartum with Seizures and Combative Behavior
- Single most likely diagnosis
- Postpartum preeclampsia/eclampsia: This condition is a leading cause of maternal morbidity and mortality, especially in the postpartum period. The presentation of seizures, despite being normotensive, could be due to the fact that preeclampsia can sometimes present with normal blood pressure readings, especially if the patient is being treated with antihypertensives or if the condition is evolving. Lower extremity edema is also consistent with this diagnosis.
- Other Likely diagnoses
- Postpartum psychosis: Although less common, postpartum psychosis can present with combative behavior and, in rare cases, seizures, especially if there is an underlying condition such as bipolar disorder. The administration of Versed (midazolam) could potentially exacerbate or precipitate psychotic symptoms in susceptible individuals.
- Post-ictal state or status epilepticus: Given the patient's seizures, a primary neurological condition such as epilepsy or a new-onset seizure disorder could be considered. The combative behavior could be part of a post-ictal confusion state.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Intracranial hemorrhage or stroke: These conditions can present with seizures and altered mental status. Given the postpartum state, the risk of venous thromboembolism and subsequent stroke or cerebral venous sinus thrombosis is increased.
- Infection (e.g., meningitis, encephalitis): Infections of the central nervous system can cause seizures, confusion, and combative behavior. In the postpartum period, the risk of certain infections may be increased.
- Amniotic fluid embolism (if the patient had recent obstetric intervention): Although less likely given the timeframe, amniotic fluid embolism can cause seizures, cardiovascular collapse, and coagulopathy.
- Rare diagnoses
- Thrombotic thrombocytopenic purpura (TTP) or hemolytic uremic syndrome (HUS): These conditions can present with neurological symptoms, including seizures, and are associated with significant morbidity and mortality if not promptly recognized and treated.
- Reversible cerebral vasoconstriction syndrome (RCVS): This rare condition can cause seizures, headaches, and altered mental status, often in the setting of postpartum or exposure to certain medications.