PRES is a neurological condition that predominantly affects the parietal-occipital region and presents with a variety of neurological symptoms. We present a rare case of a 68-year-old Caucasian male with a history of hypertension who presented to the ED with headaches, vision changes, vomiting, altered mental status, significantly elevated blood pressure, and a generalized seizure with no prior history of seizures. He was immediately started on Cleviprex drip and the initial CT scan was negative. After a second seizure, he developed rightward eye deviation and loss of gag reflex, and thus, was intubated and started on Keppra. MRI imaging showed increased symmetric T2 signaling bilaterally in his hippocampi and was subsequently diagnosed with an atypical form of PRES, after an inconclusive extensive workup and clinical improvement with blood pressure control. Surprisingly, following extubation, the patient exhibited persistent short-term memory loss (STML). With no further seizures, controlled blood pressure and improved mentation, the patient was discharged to rehab. While in rehab, he continued to demonstrate STML with MRI imaging continuing to show bilateral hippocampal atrophy. Currently, there are no reported cases showing an association of PRES with isolated hippocampal involvement.