Aims <p>This study aims to examine clinical, laboratory, neuroimaging and perinatal differences between pregnant women with isolated PRES and those with concurrent HELLP syndrome, thus improving clinicians’ understanding of these conditions.</p> Methods <p>A cross-sectional analysis was performed on 60 pregnant and postpartum women diagnosed with PRES at the Affiliated Hospital of Xuzhou Medical University, spanning from January 2014 to March 2024. These patients were divided into two groups based on laboratory findings: the isolated PRES group and the PRES-HELLP group. The study compared general clinical parameters (risk factors, neurological symptoms), laboratory tests, neuroimaging data (affected brain regions), and perinatal outcomes between the two groups.</p> Results <p>The study included 40 patients with isolated PRES and 20 patients with PREScombined with HELLP syndrome. Patients in the PRES-HELLP group exhibited lower platelet count, platelet-to-lymphocyte ratio (PLR), serum albumin (ALB), serum sodium ion (Na⁺), serum total calcium ion (Ca²⁺), and Apgar scores (both at 1 and 5&#xa0;min), along with elevated CRP, liver enzymes, and urea levels compared to those in the PRES group (<i>P</i> &lt; 0.05).</p> Conclusions <p>Concurrent HELLP syndrome exacerbates maternal and fetal risks in pregnant women with PRES, emphasizing the significance of prompt recognition.</p>