We present five cases of hypertensive encephalopathy in children, three with MR imaging findings and two with CT findings alone. One of the five patients had MR perfusion imaging, which showed perfusion abnormalities that support the concept of vasodilation as the major contributor to the syndrome. Hypertensive encephalopathy is rarely reported in children, and its true prevalence may be underestimated. Characteristic lesions in the severely hypertensive child should be recognized as manifestations of hypertensive encephalopathy, and subsequent clinical management should focus on treatment of the hypertension and/or its underlying causes.