Pediatric brain is anatomically different from adult brain, and so are the pathophysiology and management of the pediatric head injuries. The physiologically immature brain of a child is more prone to cerebral edema and diffuses axonal injuries. The common delayed complications are formation of leptomeningeal cysts and postconcussion syndrome.¹ It is very rare to have posterior reversible encephalopathy syndrome (PRES) as a complication of traumatic brain injury (TBI) in children. Therefore, it was a diagnostic dilemma for us when bilateral occipital, frontal, and parietal hyperintensities on T2-weighted MRI (magnetic resonance imaging) images complicated the recovery of a child after TBI. We shall discuss the salient aspects of management and the role of MRI in pediatric TBI. The cause of PRES and differential diagnosis will also be explored. Key messages: Diagnosis of PRES in children with no known comorbidity requires a high degree of suspicion for early recognition with the use of MRI brain.