High-Grade Glioma Mimicking Eclampsia in Pregnancy: A Case Report

Eclampsia is the most common cause of new-onset seizures after 20 weeks of gestation and requires immediate treatment.However, not all seizures in pregnancy are caused by hypertensive disorders, and structural intracranial lesions may present with similar clinical features.A 39-year-old primigravida at 25+6 weeks' gestation presented to Prashanth Super Speciality Hospital with severe hypertension (200/100 mmHg), proteinuria, altered sensorium, and recurrent generalized tonicclonic seizures.She was initially managed as eclampsia with suspected posterior reversible encephalopathy syndrome (PRES).Owing to maternal instability, an emergency lower-segment caesarean section was performed.Persistent neurological impairment after delivery prompted neuroimaging.Computed tomography demonstrated a left frontal intracerebral haemorrhage, while magnetic resonance imaging revealed a haemorrhagic left frontal mass with surrounding oedema, midline shift, and PRES-like imaging features.Following urgent neurosurgical intervention, the patient underwent left frontal craniotomy and complete tumour excision.Histopathological examination confirmed a high-grade glioma.The patient recovered well postoperatively and was referred to the neuro-oncology team and subsequently underwent adjuvant radiotherapy and chemotherapy.The neonate was delivered at 25+6 weeks' gestation and died on day 2 of life despite neonatal intensive care.This case demonstrates that structural brain tumours may closely mimic eclampsia, even in the presence of severe hypertension and proteinuria.Persistent neurological abnormalities following standard treatment for eclampsia should prompt urgent neuroimaging to exclude underlying intracranial pathology.Early multidisciplinary collaboration between obstetricians, critical care specialists, radiologists, neurologists, neurosurgeons, neonatologists, and oncologists is essential to optimise maternal outcomes.