Altered Mental Status in the Parturient: Uncovering Non-Convulsive Status Epilepticus

Abstract

Patients presenting to labor and delivery with altered mental status (AMS) present unique challenges for anesthetic management, as the underlying etiology may be unclear, and clinical decisions often evolve rapidly. Non-convulsive status epilepticus (NCSE) is an important but easily overlooked cause of persistent AMS in pregnancy. We describe a 27-year-old patient at 38 weeks of gestation who presented in a postictal state following a witnessed seizure. She was admitted to the obstetric floor for monitoring, and subsequent workup revealed refractory NCSE diagnosed by electroencephalography (EEG). As her neurologic status worsened, the decision was made to proceed with expedited cesarean delivery under general anesthesia for fetal and maternal protection. This case highlights the importance of early diagnostic evaluation, flexibility in anesthetic planning, and multidisciplinary collaboration when managing parturients with AMS.