The association between seizures and blood pressure elevation remains a common medical emergency encountered in an ICU setting. Syndromes such as pre-eclampsia or eclampsia, hypertensive encephalopathy, and posterior leukoencephalopathy commonly present with seizures. The primary treatment goal is to reduce the arterial blood pressure. In most cases seizure control is thus achieved, but unique medications, such as magnesium sulfate, may be needed. Fortunately, if treated immediately and aggressively, the pathophysiologic mechanism leading to seizures is reversible in most cases. Delayed treatment may result in irreversible brain injury or increased mother or fetus mortality.