Introduction: Malignant PRES was diagnosed with clinical assessments, radiographic evidence and clinical decline despite standard treatment. It carries high mortality of 16-29%.

Case Report: Mdm K, 28 year old lady Para 1 underwent Caesarean section for poor progress of labour. She was well post surgery. Two days following Caesarean Section, she developed left sided body weakness and confusion. No history of trauma. On examination her vitals are stable. Her GCS was E4, G4, M5. Her power was 1/5 over the left side. She underwent CT scan. A differential of cerebral venous thrombosis and PRES was made. Her condition worsened and she was intubated and ventilated on Day 3 post surgery. She was managed by the neuromedical, anesthesia and O&G team in the ICU. She succumbed on Day 20 post Caesarian section despite all the care.

Conclusion: Although the mortality rate is high, early recognition is important as the treatment can be given. A combined approach in management is important. This involved multiple disciplines i.e.  Anesthesia, Nueromedical and O&G.