The Brazil Current Overshoot regions feature the strongest sea surface temperature variations over the global ocean but forecast skill for these extreme variations is limited. Here we investigate the drivers of marine heatwaves and cold spells in this region and find that ocean flows and sea surface heat fluxes are the primary drivers. We also find that sea surface temperature extremes driven by air-sea heat fluxes produce consistent changes in sea surface temperature and related atmospheric variables over a wide horizontal area, whereas ocean flow-driven sea surface temperature extremes exhibit low consistency in air variables and limited consistency in the spatial extent of sea variables across most sea surface temperature extreme events. These differing air-sea characteristics associated with extremes driven by different drivers offer potential avenues for improving prediction skills and advancing the understanding of three-dimensional air-sea impacts associated with extreme events.