Differential Diagnosis
- Single most likely diagnosis:
- Preeclampsia: This condition is characterized by new-onset hypertension and often proteinuria after 20 weeks of gestation. The patient's increased blood pressure, headache, and visual disturbances are consistent with preeclampsia. The primary component in the pathogenesis of preeclampsia is abnormal remodeling of spiral arteries, which leads to placental ischemia and the release of factors that cause endothelial dysfunction.
- Other Likely diagnoses:
- Chronic hypertension with superimposed preeclampsia: Although the patient's blood pressure was normal in the first trimester, it's possible that she has underlying chronic hypertension that has been exacerbated by pregnancy.
- Gestational hypertension: This condition is characterized by new-onset hypertension after 20 weeks of gestation without proteinuria or other signs of preeclampsia.
- Do Not Miss diagnoses:
- Eclampsia: Although the patient is not seizing, eclampsia is a life-threatening condition that can occur in patients with preeclampsia. It's essential to monitor the patient closely for signs of eclampsia.
- HELLP syndrome: This condition is characterized by hemolysis, elevated liver enzymes, and low platelet count. It can occur in patients with preeclampsia and is associated with high morbidity and mortality.
- Rare diagnoses:
- Posterior reversible encephalopathy syndrome (PRES): This condition is characterized by headache, visual disturbances, and seizures, often associated with hypertension. Although it's rare, PRES can occur in pregnant women with preeclampsia.
- Cerebral vasculitis: This condition is characterized by inflammation of the blood vessels in the brain, which can cause headache, visual disturbances, and other neurological symptoms. Although it's rare, cerebral vasculitis can occur in pregnant women.