Objective To investigate the clinical manifestations and features of MRI of the atypical posterior reversible encephalopathy syndromes (PRES). Methods The clinical data of 5 patients with atypical PRES in our hospital were collected, analyzed the clinical manifestations and the features of MRI images. Results There are 1 male and 4 female in the 5 atypical PRES patients. Related factors included essential hypertension (1 cases), cesarean section postoperative hypertension (3 cases) and renal insufficiency hypertension (1 cases). Mean peak systolic blood pressure at presentation was 188 mmHg. The main clinical symptoms were headache. Patients recovered in 2-14d. Head MRI: Lesions occurred mainly in the frontal lobe (1 cases), brain stem (3 cases) and basal ganglia (1 cases).3 cases of them with other lesions and only 1 cases with right parietal occipital lobe lesion.T1WI lesions showed equal or slightly low signal. FLAIR and T2WI lesions showed high signal. Most (4 cases) DWI lesions showed equal or low signal and ADC showed high signal. Small (1 cases) DWI lesion showed high signal and ADC showed equal signal. The lesions had different degrees of reduction or disappearance when patients review MRI after 2-4 weeks of treatment. Conclusion The clinical manifestations of atypical PRES are not typical, but still have characteristics with MRI examination. Imaging diagnosis of doctors should improve the knowledge, especially for the underlying disease. Clinical symptoms and MRI findings were inconsistent, need to consider the possibility of this disease.