Eclamptic seizures are a known complication of pregnancy; less well publicized is the patient with late postpartum eclampsia. Late postpartum eclamptic seizures are convulsions that occur more then 48 hours after delivery. Because 40% of patients who have late postpartum eclampsia do not experience preeclampsia, clinical awareness is essential for early treatment and care. (American Journal of Critical Care. 2010;19:307,305-306) E clamptic seizures are a known complication of the final trimester of pregnancy, but less recognized is late postpartum eclampsia (LPPE), also called delayed postpartum eclampsia. Late postpartum eclamptic seizures are convulsions that occur between 48 hours and 4 weeks after delivery. 1-3 Forty percent of patients who have LPPE do not experience preeclampsia 1 and may have been asymptomatic before the convulsion. More than 20% of all eclamptic seizures occur more then 48 hours after delivery. 2 The etiology of late LPPE is believed to be similar to that for preeclampsia; however, both are not fully understood, and studies to clarify the etiology of both preeclampsia and LPPE are ongoing.Kathy (not the patient's actual name), a 28-yearold woman, came to the emergency department at our community hospital 6 days postpartum (para 1, gravida 1) after having 2 tonic-clonic seizures. The first was witnessed by her husband, and the second occurred en route to the hospital in the ambulance and required intubation. Kathy's uneventful pregnancy was followed by staff at a tertiary care center because of her history of idiopathic panhypopituitarism. She delivered via cesarean section after a failed induction. She had an epidural during her prolonged labor, but had no headaches while in the hospital. She was discharged with an appointment for 6-week follow-up. No additional blood work or blood pressure checks were required.While Kathy was in the emergency department, the initial physical examination showed an obtunded woman who gradually woke up. She was extubated and had normal findings on a neurological examination except for unequal pupils. Kathy reported a headache and her blood pressure was elevated Continued on page 305Cases of Note features peer-reviewed case reports and case series that document clinically relevant findings from critical and high acuity care environments. Cases that illuminate a clinical diagnosis or a management issue in the treatment of critically and acutely ill patients and include discussion of the patient's experience with the illness or intervention are encouraged. Proposals for future Cases of Note articles may be e-mailed to ajcc@aacn.org. ©2010 American Association of Critical-Care Nurses doi: 10.4037/ajcc2010668by AACN on May 10, 2018 http://ajcc.aacnjournals.org/ Downloaded from (170s/90s) from her baseline (100s/60s). Despite her history of panhypopituitarism, she had normal results on a comprehensive metabolic panel. The urinalysis showed proteinuria but findings were otherwise negative. Computed tomography of her head showed normal findings. Magnet...