Cognitive impairment is common following stroke. The clinical course and presentation are variable in vascular dementia, but the diagnosis can often be tied to recent vascular events or to progressive white matter lesions on MRI. Because there is considerable overlap between patients with vascular and Alzheimer’s type dementia, both acetylcholinesterase inhibitors and memantine have been tried off-label to treat the cognitive symptoms of vascular dementia with mixed results.
Posterior reversible encephalopathy syndrome is a clinical–radiographic syndrome of progressive headaches, blurred vision, confusion, and seizures in the setting of vasogenic edema on brain imaging, which is often localized to the posterior white matter. The symptoms are classically triggered by severe hypertension, pregnancy and the puerperium, or exposure to immunosuppressive medications. The symptoms can be reversible if the offending etiology is quickly removed, but permanent deficits can remain if strokes or hemorrhage complicate the clinical course.
Childhood white matter disorders: much more than just diseases of myelin
