Background:
Neurological symptoms are common in pregnancy and frequently overlap with the clinical spectrum of pre-eclampsia. Headache, visual disturbance, dizziness, nausea, sensory symptoms, and altered cognition are often initially attributed to hypertensive disease, physiological pregnancy changes, or benign conditions. While timely recognition of neurological manifestations of pre-eclampsia is critical, premature diagnostic closure may lead to missed or delayed diagnosis of significant neurological pathology.
Objective:
This presentation aims to highlight the importance of maintaining a broad neurological differential diagnosis in pregnant and postpartum women presenting with symptoms suggestive of pre-eclampsia.
Clinical Perspective:
Using illustrative maternal medicine cases, this presentation explores how common neurological complaints may represent conditions other than pre-eclampsia, including cerebral venous sinus thrombosis, intracranial haemorrhage, reversible cerebral vasoconstriction syndrome, migraine with aura, meningitis, demyelinating disease, seizure disorders, and space-occupying lesions. Cases will demonstrate how anchoring bias toward pre-eclampsia can contribute to delayed neuroimaging, specialist referral, and definitive treatment. Particular focus will be placed on recognising atypical headache patterns, focal neurological deficits, persistent visual symptoms, altered behaviour, and symptoms disproportionate to blood pressure findings.
The discussion will also examine practical strategies for clinicians, including identifying “red flag” neurological symptoms, revisiting differential diagnoses when the clinical trajectory is atypical, and promoting multidisciplinary collaboration between obstetric medicine, neurology, anaesthesia, and critical care teams.
Conclusion:
Not every neurological symptom in pregnancy is pre-eclampsia. Maintaining diagnostic curiosity and recognising atypical neurological presentations are essential to avoiding delay, reducing maternal morbidity, and improving outcomes in obstetric medicine.