Introduction: Hypertensive encephalopathy which occurs in renovascular hypertensive crisis could be a diagnosis trap in geriatrics. Objective: Establishing an adequate medical attitude for geriatric patients with atypical onset (psychiatric symptoms) of renovascular hypertension. Methods: Clinical examination, electrocardiogram, transthoracic echocardiography, renal arteries sonography, biochemical and hematological findings were utilized for a proper diagnosis. Results: The geriatric patient developed a hypertensive encephalopathy, with psychiatric manifestations; this complication occurred after an inadequate medicine for bilateral renal artery stenosis. Conclusions: The complete screening (laboratory findings, imagistic methods) and multidisciplinary evaluation are recommended for geriatric patients with psychiatric disorders.