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However, atypical presentations can occur in the absence of elevated blood pressures. We present the case of a pregnant patient who developed status epilepticus at 24\u2009weeks and 4\u2009days of gestation, followed by altered mental status and severely elevated transaminases. She had no elevated blood pressures during her prenatal care or hospital course. Following delivery, she experienced normalization of transaminase levels and a return to her baseline mental status. Pre\u2010eclampsia and eclampsia can occur in the absence of elevated blood pressures, which highlights the limitations of using standard diagnostic criteria in normotensive patients with end\u2010organ damage. In such cases, it is important to include pre\u2010eclampsia and eclampsia in the differential diagnosis, as the diagnosis usually warrants preterm delivery to minimize maternal morbidity and mortality.<\/jats:p>","DOI":"10.1002\/ijgo.14975","type":"journal-article","created":{"date-parts":[[2023,7,3]],"date-time":"2023-07-03T10:53:47Z","timestamp":1688381627000},"page":"476-481","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Atypical eclampsia in a normotensive patient with altered mental status and severely elevated transaminases: Case report and review"],"prefix":"10.1002","volume":"164","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8918-1623","authenticated-orcid":false,"given":"Tejal","family":"Ghadiali","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Keck School of Medicine of the University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4908-958X","authenticated-orcid":false,"given":"Michelle T.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology Keck School of Medicine of the University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard H.","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology Keck School of Medicine of the University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8346-2136","authenticated-orcid":false,"given":"Elizabeth B.","family":"Sasso","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology Keck School of Medicine of the University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,3]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003891"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.07.048"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767050600678337"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1447-0756.2005.00292.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000152351.13671.99"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182324570"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1998.tb10090.x"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2009.02.004"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0000000000000494"},{"key":"e_1_2_9_11_1","volume-title":"StatPearls [Internet].","author":"Lala V","year":"2021"},{"key":"e_1_2_9_12_1","volume-title":"LiverTox: Clinical and Research Information on Drug\u2010Induced Liver Injury","author":"Hoofnagle JH","year":"2019"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebr.2021.100464"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40800-015-0018-0"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/1756-0500-6-421"},{"key":"e_1_2_9_16_1","volume-title":"Wilson Disease","author":"Chaudhry HS","year":"2021"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wombi.2008.09.003"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.5152\/jtgga.2010.014"},{"issue":"2","key":"e_1_2_9_19_1","first-page":"1","article-title":"Atypical eclampsia with PRES syndrome","volume":"4","author":"Nasare P","year":"2017","journal-title":"J Postgraduate Gyn Obstetrics"},{"key":"e_1_2_9_20_1","first-page":"706","article-title":"Eclampsia in the first half of pregnancy. 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