Mild neurological symptoms in preeclampsia before cesarean delivery: A warning for intracranial hemorrhage

Mild neurological symptoms in pregnant women with preeclampsia may represent early manifestations of intracranial hemorrhage. This letter discusses the clinical significance of subtle neurological abnormalities detected before emergency cesarean delivery and the challenges of balancing obstetric urgency with the need for neurological assessment, illustrated by a clinical case. A 28-year-old woman at 35 weeks of gestation underwent emergency cesarean delivery because of hypertension and fetal distress. Preanesthetic assessment revealed dysphasia and mild confusion. Fetal bradycardia and the need for immediate delivery precluded advanced neurological evaluation and preoperative neuroimaging. Blood pressure before induction was 150/110 mmHg. Cesarean delivery was performed under general anesthesia, with stable intraoperative hemodynamics. Eight hours postoperatively, worsening confusion and neurological deficits prompted cranial computed tomography, which demonstrated an acute left temporoparietal intraparenchymal hemorrhage. The patient received conservative treatment in the intensive care unit without surgical intervention and was discharged with permanent Wernicke’s aphasia and hemiplegia.Preeclampsia may predispose patients to cerebrovascular complications through endothelial dysfunction, impaired cerebral autoregulation, and vasogenic edema. Accordingly, mild confusion, speech disturbances, and behavioral changes warrant assessment. Although obstetric emergencies may restrict opportunities for preoperative imaging, unavoidable delivery-related constraints should be distinguished from preventable delays in neurological evaluation. Management priorities include effective blood pressure control, maintenance of coagulation stability, avoidance of hypertensive responses during anesthetic induction and emergence, and close postoperative neurological monitoring.Subtle neurological findings in preeclampsia may signal serious intracranial pathology. Persistent focal deficits or progressive mental status changes should prompt urgent neurological consultation and consideration of neuroimaging whenever feasible. Clinically indicated imaging should not be deferred solely because of pregnancy.