Headache is a common but often overlooked symptom in patients with pheochro­mocytoma, and it is essential to consider this diagnosis in patients presenting with unexplained headache, primarily when associated with other systemic symptoms such as hypertension, palpitations, and sweating. Clinical suspicion leads to early diagnosis and treatment, which are crucial for preventing complications and improv­ing outcomes. Physicians must be vigilant when evaluating prolonged headaches in the emergency setting. Medical management, including alpha and beta blockade, followed by surgical resection of the tumor, remains the cornerstone of treatment. Prompt recognition and appropriate intervention can provide signicant relief from the debilitating symptoms associated with this rare but signicant condition.

for vasogenic oedema. Additionally, subtle hyperintensities in the cerebellar hemi­spheres—particularly on the right—further support a posterior circulation vulnera­bility. Diffusion-weighted imaging (DWI) shows mild hyperintensities without corresponding low signal on apparent diffusion coefcient (ADC) maps; instead, the ADC values are elevated, indicating facilitated diffusion and conrming the presence of vasogenic rather than cytotoxic oedema. The absence of true diffusion restriction effectively rules out acute infarction. These ndings reect the patho­physiology of PRES, in which severe hypertension overwhelms the cerebral auto­regulatory mechanisms, especially in posterior circulation territories with relatively less sympathetic innervation, leading to transient blood–brain barrier disruption and uid extravasation into the interstitium. Collectively, the imaging demonstrates the classic radiologic pattern of PRES, supporting a diagnosis of reversible vasogenic oedema due to hypertensive encephalopathy. Given the clinical and radiological ndings, Zeynep was diagnosed with hypertensive encephalopathy in the context of severe preeclampsia, with radiological features of PRES.

encephalopathy, including elevated blood pressure, headache and visual distur-

bances. However, systemic ndings such as proteinuria, elevated liver enzymes

However, the diagnostic process is complicated by the broad differential diagno­sis of headaches in hypertensive and pregnant patients. In pregnant individuals like the case presented, differentials include preeclampsia/eclampsia, cerebral venous sinus thrombosis (CVST), reversible cerebral vasoconstriction syndrome (RCVS), pituitary apoplexy and even migraine with aura. Each may present with similar neurological signs and symptoms, including headache, visual changes and altered consciousness [3, 11].

Differentiating hypertensive encephalopathy from eclampsia is particularly criti­cal in obstetric patients. Both conditions may involve elevated blood pressure, sei­zures and cerebral oedema, yet eclampsia often includes additional systemic features such as proteinuria, hepatic dysfunction and thrombocytopenia. Neuroimaging in both conditions may show PRES patterns, further complicating the diagnosis. Nonetheless, the presence of isolated neurological symptoms with a radiologic PRES pattern, in the absence of systemic signs, leans toward primary hypertensive encephalopathy [4].

• Hypertensive encephalopathy is pathophysiologically distinct from but radio-

with aura. Systemic ndings and dynamic neuroimaging features aid in differen-

identifying vasogenic oedema, ruling out infarction or haemorrhage and evaluat-

Papilledema and hypertensive retinopathy ndings can guide urgency and indi-