Exclude eclampsia early.

group is not without risk and needs careful monitoring, many patients can take these drugs judiciously for short periods only. We report on a woman whose eclampsia was misdiagnosed. Case report A 35 year old West Indian woman was seen in the casualty department after having four seizures. She was an unmarried mother of one child and was on holiday in the United Kingdom. She was conscious and lucid and on direct questioning denied being pregnant. She was endorphic (weight 96 kg, height 163 cm), with a blood pressure of 135/65 mm Hg and 3+ proteinuria; she was considered to have generalised oedema. Findings on neurological examination were unremarkable. Four hours after admission she had a seizure, characterised by tonic-clonic movements of her arms and legs, and was incontinent of urine. Her blood pressure was 200/130 mm Hg and her proteinuria persisted. She was given an intravenous bolus of diazepam, paracetamol, nifedipine, and frusemide. Investigations showed raised aspartate transaminase (53 U/1) and alkaline phosphatase (630 U/l) activities and a low serum albumin concentration (17 g/l). Results of haematological tests and urea and electrolyte concentrations were normal. Because of her proteinuria, hypoalbuminaemia, and oedema she was given a high protein diet and her fluid balance was strictly controlled. Her weight fell from 96 kg to 89 kg. She was considered clinically to have ascites, and so on day 6 a drain was sited in her right flank; one litre of fluid was drained over 24 hours. A brain scan on day 7 showed a localised 2 cm lesion in the right parietal lobe with associated bilateral cerebral oedema, and a primary or secondary tumour was diagnosed provisionally. The fluid obtained by paracentesis was reported as containing chorionic or mesothelial cells. A pelvic mass was now palpable, and an ultrasound scan showed a fetus with no signs of life. She was referred to obstetricians. A further scan showed a fetus with no signs of life and oligohydramnios. The patient's serum urate concentration was 728 [tmol/l, she had 3+ proteinuria, and her diastolic blood pressure was 128 mm Hg. Labour was induced with extra-amniotic prosta-glandin, and her blood pressure was controlled with an infusion of hydralazine. A fetus weighing 1100 g was delivered; the patient refused permission for a post-mortem examination. The postpartum period was uneventful, and she was subsequently discharged. A repeat brain scan 21 days after the first did not show …