We present a case of a 78-year-old African-American man with a history of hypertension, and with no prior history of seizure. The patient presented with hypertensive urgency as well as stroke such as symptoms of confusion, seizure, postictal confusion, left hemianopsia and hyponatraemia. MRI findings were suggestive of posterior reversible encephalopathy syndrome (PRES). The patient was treated with appropriate medications with the resolution of his stroke-like symptoms. This case report discusses a patient with PRES, in the setting of hyponatraemia, and how prompt recognition may prevent permanent neurological sequela such as epilepsy.