Pre-eclampsia is a syndrome unique to human pregnancy characterized by the new onset of hypertension and proteinuria after 20 weeks of gestation in previously normotensive, nonproteinuric women. HELLP syndrome is associated with poor outcome to pregnancy and even maternal and fetal death. The pre-eclampsia-eclampsia syndrome commonly occurs in women with underlying microvascular diseases, particularly chronic hypertension, diabetes, renal disease, or autoimmune disease. The diagnoses of pre-eclampsia and eclampsia are based on clinical symptoms and signs and on laboratory abnormalities. Recognition of stroke with severe pre-eclampsia and eclampsia (SPE/E) includes the development of sudden onset of focal neurological deficits in patients who have the neurologic features of headache, confusion, and seizures. Brain imaging has become essential in properly diagnosing acute neurological changes in pregnant women. The differential diagnosis of SPE/E includes dural sinus thrombosis and a reversible cerebral vasoconstriction syndrome. Magnesium has been the key treatment of eclampsia for many years.