The diagnosis of hypertensive encephalopathy is highly dependent on the exclusion of other neurological emergencies. We look at the vast causes of PRES and its visual characteristics. Treatment strategies have not changed significantly over the past decade, although new calcium channel blockers are simplifying the approach to lowering blood pressure. Although in most cases this may be sufficient to treat hypertensive encephalopathy, treatment for PRES also depends on the modification of other provoking factors. Hypertensive encephalopathy and PRES are overlapping disorders for which an intense decrease in blood pressure is critical. Further research is needed both for diagnosis and for complementary treatment strategies for these critical conditions.