SUMMARY Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare clinical syndrome, which is manifested clinically by headache, seizure, altered mental status, and a spectrum of visual deficits ranging from visual neglect to cortical blindness. We present a case of postpartum women who developed RPLS after combined-spinal epidural anesthesia which was complicated by a postdural puncture headache. She was treated with magnesium sulfate, midazolam, mannitol and carbamazepine for seizure control and prophylaxis. Her blood pressure was controlled with labetolol and nicardipine. She was discharged home two weeks later with no neurologic deficit and repeated MRI showed normal. Cerebral Magnetic resonance imaging (MRI) study is diagnostic of RPLS. The hallmark feature is bilateral symmetrical vasogenic edema in the territories of the posterior cerebral circulation (occipital and posterior parietal lobes). If promptly recognized and treated, complete recovery of symptoms is the norm and the neuroradiographic changes are reversible when blood pressure is controlled. However, when the dignosis is delayed or unrecognized, cerebral ischemia and infarction can occur, resulting in permament brain injury or death.