Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity that can present with a heterogeneous spectrum of clinical and radiological findings. Patients with atypical PRES are often misdiagnosed on their initial neuroimaging leading to delayed or unnecessary treatments. We present a case of an atypical presentation of PRES in a postpartum woman with haemolysis, elevated liver function tests and low platelet count (HELLP) syndrome. She was initially suspected and treated as having a posterior circulation stroke, due to atypical early stage unilateral asymmetrical oedema in the pons and cerebellum. Interpretation of the neuroimaging is crucial to the diagnosis of PRES. The complex neuroimaging of our case, in addition to the radiological features of typical and atypical PRES are presented. This case highlights the importance of clinicians having a low index of suspicion for PRES in such patients to ensure necessary serial neuroimaging occurs, and the diagnosis of PRES is accurately established.