Atypical eclampsia without severe hypertension - the role of ophthalmic artery Doppler and sFlt-1/PlGF ratio: a case report.

Eclampsia remains one of the most severe obstetric emergencies associated with substantial maternal and perinatal morbidity and mortality. Although classically regarded as a hypertensive complication of pre-eclampsia, atypical presentations without sustained hypertension or severe clinical features may occur, complicating risk prediction and timely intervention. We report a case of atypical eclampsia in a 21-year-old woman hospitalized with a diagnosis of pre-eclampsia without severe features. Despite predominantly normal blood pressure values and initially stable laboratory findings, the sFlt-1/PlGF ratio and Doppler assessment of the uterine and ophthalmic arteries revealed significant abnormalities. The patient subsequently developed generalized tonic-clonic seizures, requiring urgent obstetric intervention. This case underscores the limitations of conventional diagnostic criteria in identifying patients at risk for sudden neurological deterioration and highlights the potential value of angiogenic biomarkers and targeted Doppler evaluation in refining risk stratification among women with pre-eclampsia.