These are case series with six patients who presented with Posterior reversible encephalopathy syndrome related to severe hypertension due to various causes managed by neurology team based in DGH & Tertiary neurosciences centre. This series shows the diversity of its presentation and quick recognisation and management would help in reversing the damage but there are situation were controlling hypertension becomes difficult due to nature of the aetiology of the hypertension as a result this could lead to non reversible damages. Posterior reversible encephalopathy syndrome also called as PRES is a clinico radiological syndrome with severe hypertension, altered sensorium, seizures, visual symptoms and MRI features of changes involving predominantly the occipitopareital areas, cerebellum, BS. Prompt treatment with antihypertensive to bring down the blood pressure had been effective in reversing the damage. Understanding the tolerability and the safe practice in management of hypertension and possible adverse effects due to difficulties in controlling blood pressure with various comorbidity is very important. At present commonly used protocols are Labetalol or Glyceryl tri nitrate infusion and maintenance with single or combination therapy. Most of the critical care physicians worldwide favour labetalol and sodium nitroprusside with caution. What ever antihypertensive agents we use the evidences suggest to concentrate in bringing mean arterial pressure down by 25% in first 2–4 h is a reasonably approach. PRES is otherwise a neurological emergency which can present as severe head ache, status epilepticus, posterior circulation infarct, acute visual loss? cause with severe hypertension.
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