A patient with severe preeclampsia develops sudden hemiparesis and confusion. Which of the following is the most urgent diagnostic concern and initial management priority?

• A. Immediate initiation of long-term oral antihypertensive therapy and outpatient physical therapy without neuroimaging because stroke is unlikely in pregnancy-related hypertensive disorders.
• B. Diagnose eclampsia and treat with oral hypoglycemic agents because neuro deficits in preeclampsia are almost always due to hyperglycemia.
• C. Assume transient postictal weakness from a past seizure and discharge with instructions for bed rest and no further evaluation.
• D. Possible intracerebral hemorrhage or ischemic stroke related to severe hypertension; urgent neuroimaging and aggressive blood pressure control while preparing for possible critical care interventions.

Answer: (D)