SEIZURES ON POSTPARTUM DAY SEVEN. K. Gustafson 1 , R. Khurana 1 ; 1 University of Alberta, Edmonton, Alberta. (Tracking ID #76917) LEARNING OBJECTIVES: 1) To recognize that preeclampsia and eclampsia may occur in the postpartum period. 2) Diagnose eclampsia even when it presents without the typical signs of preeclampsia. We describe a case of postpartum eclampsia that was initially misdiagnosed. CASE INFORMATION: A 28 year old woman G2P2 was transferred to our tertiary case hospital on postpartum day 7 because of seizures. Her pregnancy had been uncomplicated and she had a vaginal delivery at term for a healthy 3515g female infant. Her past medical history was unremarkable and her blood pressure had remained normal throughout the pregnancy. She presented to a local hospital on postpartum day 7 complaining of severe headache, nausea and vomiting. Her blood pressure was 176/100. She was given analgesia, but then had two generalized seizures. She was given magnesium sulfate 5 g intravenously and transferred. When assessed, her blood pressure was 150/90. She had no focal neurologic findings, right upper quadrant tenderness, edema or hyperreflexia. Her liver enzymes and platelet count were normal. Urinalysis was negative for protein. Urate was slightly elevated. CT scan of the head was normal. EEG was normal. She was seen by the services of Neurology, Internal Medicine and the Intensive Care Unit. She was diagnosed with seizures of unknown origin and admitted for observation. The magnesium sulfate was discontinued. Her blood pressure varied over the next two days from 124/81 to 200/103. On postpartum day 10, she had another generalized seizure. MRI of her brain was consistent with hypertensive encephalopathy. She was given a diagnosis of postpartum eclampsia and treated with intravenous magnesium sulfate and antihypertensive therapy. She improved over the next few days and all therapy was discontinued. She remains well with no further seizure activity. IMPLICATIONS/DISCUSSION: Preeclampsia/eclampsia may worsen or even initially present in the postpartum period. Postpartum eclampsia represents 25% of all cases of eclampsia. The majority of these events occur in the first 24±48 hours postpartum, but have been reported to occur as late as 4 weeks postpartum. Eclampsia does not always occur in patients who have the classic triad of preeclampsia (hypertension, proteinuria and edema). About 20% of patients with eclampsia have no proteinuria. Computed tomography and EEG are often unremarkable, but should be performed to rule out other causes of seizure. When MRI abnormalities are present, hyperintense signals in cortical and subcortical areas on T2 weighted images may be seen. These are usually in the posterior parietal or occipital lobes. Management of eclampsia includes delivery of the fetus (if diagnosed antepartum), magnesium sulfate to prevent recurrent seizures and control of severe hypertension. A high index of suspicion is necessary to appropriately diagnose the woman with postpartum eclampsia and prevent further morbidity. LEARNING OBJECTIVES: To recognize focal muscle infarction as an unusual, and sometimes bilateral, cause of severe limb pain in patients with diabetes. CASE INFORMATION: A 55 year-old diabetic woman developed disabling pain in both upper legs, with thickening and tenderness of the soft tissues of the right lateral thigh. There was no evidence of infection. She had neuropathy but sensation in the thighs was normal. There was a history of disc disease but an MRI examination of the spine was unimpressive. She had arterial disease but ankle/brachial indices were only in the claudication range. There was a history of venous thrombosis but she was taking warfarin and duplex studies showed no clots. Plain films and a bone scan were negative. MRI examination showed diffuse edematous infiltration of the subcutaneous fat of both thighs, with increased signal in the right vastus lateralis muscle. These findings were consistent with infarction of the vastus lateralis, and conservative treatment was recommended. IMPLICATIONS/DISCUSSION: Diabetic muscle infarction causes pain, swelling, and tenderness, most commonly in the thigh, but sometimes in the calf. The opposite limb may be involved, either sequentially, or concurrently, as in this case. The MRI appearance is characteristic and allows the diagnosis to be made without the risks of biopsy. Treatment is supportive. This rare but important entity must be considered when diabetic patients suffer severe limb pain.