Differential Diagnosis for Postpartum Seizure
The patient's presentation of a seizure, worsening headache, and bilateral papilledema 10 days after childbirth suggests a complex differential diagnosis. The following categories outline potential causes:
Single most likely diagnosis
- Postpartum preeclampsia or eclampsia: Although the patient had an uncomplicated delivery and was discharged, the onset of a severe headache, vomiting, and a seizure, along with bilateral papilledema, points towards a hypertensive disorder of pregnancy, specifically postpartum preeclampsia or eclampsia. The family history of deep vein thrombosis may also hint at a predisposition to clotting disorders, but the primary concern here is the acute neurological presentation.
Other Likely diagnoses
- Postpartum cerebral venous sinus thrombosis (CVST): Given the headache, vomiting, seizure, and papilledema without neck stiffness, CVST is a plausible diagnosis. The patient's recent pregnancy increases her risk for venous thromboembolism.
- Reversible cerebral vasoconstriction syndrome (RCVS): This condition can present with thunderclap headache and seizures, often in the postpartum period. However, the absence of a characteristic "thunderclap" headache description makes this less likely.
- Postpartum stroke or transient ischemic attack (TIA): Although less likely given the absence of focal neurological deficits, it remains a consideration in the differential diagnosis.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage (SAH) or other intracranial hemorrhages: Despite the noncontrast CT scan being negative, it's crucial to consider SAH, especially if the initial CT was done soon after the seizure and might have missed a small bleed. A lumbar puncture could be necessary if clinical suspicion remains high.
- Meningitis or encephalitis: Although the patient does not exhibit typical signs of infection like fever or neck stiffness, these conditions can present atypically, especially in the postpartum period.
- Pituitary apoplexy: A rare but potentially life-threatening condition that could cause sudden headache, visual disturbances, and altered mental status, especially in the context of recent pregnancy.
Rare diagnoses
- Postpartum angiopathy: A rare condition that can cause headaches and seizures due to cerebral vasculopathy.
- Choriocarcinoma with brain metastases: Extremely rare, but could explain seizures and neurological symptoms in the postpartum period, especially if there were any complications during pregnancy that might suggest a trophoblastic disease.
- Other rare vascular or autoimmune conditions: Such as systemic lupus erythematosus (SLE) or antiphospholipid syndrome, which could explain seizures and other neurological symptoms, though these would be less common and typically associated with other systemic symptoms.