Differential Diagnosis

The patient presents with severe headache, blurry vision, and specific fundoscopic examination findings after giving birth. Considering her history of systemic lupus erythematosus (SLE) with antiphospholipid antibodies, the following differential diagnoses are proposed:

• Single Most Likely Diagnosis

  • Postpartum Angiopathy (also known as Postpartum Cerebral Angiopathy): This condition is characterized by severe headaches, often with visual disturbances, occurring in the postpartum period. The presence of antiphospholipid antibodies in a patient with SLE could predispose her to vascular complications, including postpartum angiopathy. The symptoms and the timing relative to childbirth make this a strong consideration.

• Other Likely Diagnoses

  • Idiopathic Intracranial Hypertension (IIH): Also known as pseudotumor cerebri, IIH can cause severe headaches, visual disturbances, and the fundoscopic findings described, such as obscured optic disc edges and flame hemorrhages. The postpartum state can be a risk factor for IIH, especially in patients with a history of autoimmune diseases like SLE.
  • Cavernous Sinus Thrombosis: Although less common, this condition can occur in the postpartum period, especially in patients with hypercoagulable states like those with antiphospholipid antibodies. Symptoms can include severe headache, visual disturbances, and cranial nerve deficits, but the latter is not mentioned in this case.

• Do Not Miss Diagnoses

  • Subarachnoid Hemorrhage: This is a medical emergency that can present with sudden, severe headache (often described as "the worst headache of my life") and can be associated with visual disturbances if the hemorrhage affects areas near the optic nerves. Although the patient's headache has been present for two days, which is less typical for subarachnoid hemorrhage, missing this diagnosis could be catastrophic.
  • Subdural Hemorrhage: Another serious condition that requires immediate attention. It can occur postpartum due to various reasons, including dural venous sinus thrombosis or direct trauma. The presence of antiphospholipid antibodies increases the risk of thrombotic events.

• Rare Diagnoses

  • Reversible Cerebral Vasoconstriction Syndrome (RCVS): This condition can present with severe headaches and is sometimes associated with postpartum status or the use of certain medications. It's less likely given the specific fundoscopic findings but could be considered if other diagnoses are ruled out.
  • Central Retinal Vein Occlusion (CRVO): While this could explain some of the visual findings, it would not account for the headache or the full spectrum of the patient's presentation. It's more of a localized condition affecting the eye rather than a systemic or cerebral issue.