Background: Intracerebral hemorrhage (ICH) is a rare but severe complication of preeclampsia, significantly contributing to maternal morbidity and mortality, particularly in resource-limited settings. The underlying mechanisms include endothelial dysfunction, cerebral
autoregulation failure, and breakdown of the blood-brain barrier. This case report aims to highlight a unique presentation of severe preeclampsia complicated by ICH, emphasizing barriers encountered in resource-limited settings and discussing long-term implications and prognosis. Case Presentation: A 35-year-old multiparous woman presented two days postpartum with altered mental status, aphasia, and rightsided hemiparesis. Her pregnancy was complicated by severe preeclampsia and intrauterine fetal death. Computed tomography (CT) revealed a left basal ganglia hemorrhage extending into the ventricles. She received conservative management including antihypertensive medications, magnesium sulfate for seizure prophylaxis, and anti-edema therapy. Despite limited diagnostic resources, laboratory evaluations ruled out coagulopathies and vascular anomalies. After 20 days of multidisciplinary care, significant neurological recovery was achieved. Follow-up after four weeks demonstrated complete functional recovery, with resolution confirmed by
repeat CT.

Conclusion: This case uniquely underscores the critical importance of timely multidisciplinary care and robust antenatal monitoring in mitigating severe complications such as ICH associated with preeclampsia. The patient’s full recovery highlights the potential for successful conservative management even in resource-constrained environments. Future clinical practice and research should focus on
improving antenatal care accessibility, patient education, and developing context-specific management guidelines to reduce materna morbidity and mortality in similar settings.
Keywords: intracerebral hemorrhage, severe preeclampsia, antenatal care, multidisciplinary management, resource-limited settings