Background and aims Preeclampsia, eclampsia, and HELP syndrome are disorders associated with substantial maternal and perinatal morbidity. Atypical cases develop at <20 weeks of gestation and >48 hours after delivery, also those that have some of the signs and symptoms without the usual hypertension or proteinuria are considered atypical, in rare cases eclampsia could be the sole sign.

Methods A healthy 35-year-old female, G2 P1001, with no significant history, presented for an elective cesarean section due to placenta previa. Spinal anesthetic was planned using 1.4 ml of hyperbaric bupivacaine 0.75%; fentanyl 15mcg and preservative free morphine 300 mcg were added to the mixture. After the block was performed standard monitors were applied and the patient was prepared to undergo surgery, fetal heart rate was 146 beats per minute. Moments after the anesthetic placement the patient complained of having the ‘worst headache of her life,’ and immediately developed a generalized tonic clonic seizure, blood pressure was noted to be 180/126 mmHg, the surgeon was alerted and general anesthesia was rapidly induced, the cesarean section took place and the delivery of the fetus was uncomplicated. At the end of the surgery the patient was extubated, physical exam was normal.

Results Brain MRI showed ‘findings suggestive of eclampsia or PRES.’

Conclusions Patient‘s history, physical examination, laboratory and imaging studies may be critical in not missing atypical forms, a management plan should be started immediately and no time consumed searching for a rare disease in a differential diagnosis; we should create awareness of atypical presentation of the disease.