Hypothesis – Simultanagnosia is common in eclampsia and a visuospatial test may be the most appropriate method in assessing the degree and monitoring of neurological deficit. Aim – To determine a sensitive clinical test for the degree of neurological deficit in eclampsia and in monitoring neurological change. Methods – Thirty women with eclampsia were evaluated by clinical neurological quantitative scales including the Canadian Neurological Scale, Glasgow Coma Scale, Mini-Mental State Examination, a validated Cookie Theft Picture Test (CTPT), magnetic resonance imaging (MRI) (T1/T2), diffusion weighted imaging (DWI) and magnetic resonance angiography (MRA). Results – The CTPT, used to measure simultanagnosia, had a sensitivity of 100% (95% CI: 84.5–100), specificity of 33.3% (95% CI: 1.8–87.5) with positive predictive value of 93.1% (95% CI: 75.8–98.8) and negative predictive value of 100% (95% CI: 5.5–100). The degree of agreement between simultanagnosia as measured by CTPT and DWI was 93.3% (Kappa=0.474; P =0.001). Standard MRI compared with DWI had a sensitivity of 77.8% (95% CI: 57.3–90.6), specificity of 100% (95% CI: 31–100), positive predictive value of 100% (95% CI: 80.8–100) and negative predictive value of 33.3% (95% CI: 9–69.1). The degree of agreement between standard MRI and DWI was 90%, this was statistically significant (Kappa=0.412: P =0.001). Conclusions – The validated CTPT for simultanagnosia was abnormal in the majority (n =29; 96.7%) of eclamptic patients with other neurological scales normal. Standard MRI and DWI showed excellent correlation with this simple bedside clinimetric evaluation. The oedema in eclampsia is primarily of vasogenic origin. [ABSTRACT FROM AUTHOR]