Abstract
A 21-year-old pregnant female with no significant past medical history presented with acute onset headache and nausea as well as tonic-clonic seizures, then rapidly decompensated into a coma with complete absence of brainstem reflexes. The patient was ultimately diagnosed with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) and subsequent posterior reversible encephalopathy syndrome (PRES) with brainstem involvement. Emergent delivery and blood pressure control resulted in rapid and complete neurologic recovery.