We present a 48-year-old man with a history of hypertension, who suddenly noticed dysarthria and right hemiparesis. Diffusion-weighted MRI at 1 day after the onset showed a small high-intensity region in the left corona radiata, indicating the acute phase of lacunar infarction. Fluid attenuation inversion recovery images showed extensive hyperintense lesions predominantly in the white matter of the fronto-temporoparietal lobes and pons, indicating posterior reversible encephalopathy syndrome (PRES). In addition, T2*-weighted gradient-echo images showed multiple small round hypointense lesions in white matter and basal ganglia, indicating cerebral microbleeds. This is a rare case of symptomatic lacunar infarction accompanied with both PRES and microbleeds, which may suggest that the pathophysiology of PRES is related to hypertension.