my mother was seen in the ER last year for r/o TIA. I was on the phone with her and she had rapid and sudden onset of slurred speech and was also repeating the same comment over and over. A CT of the head w/o contrast was dome and showed the following: -ventricles/sulci unremarkable -moderately severe patchy and confluent leukoencephalopathy present, consistent with changes secondary to microvascular disease. -scattered chronic lacunar infarcts are seen in basal ganglia and external capsules bilat. -superimposed acute infarct can not be excluded. Her hx is of mild HTN, on exforge . Mildly elevated chol, but with good ratio and excellent HDL and low triglycerides. Hx of cigarette smoking. 1/2-1pack/day x 20+ yrs and was smoking at the time of this ER visit. Fam Hx of Hashmotos thyroiditis in ALL females for at least 3 generations. Hx of anxiety, Reynauds, B12 deficiency and B12 deficient anemia. Also c/o palpitations and had a greatly increased pulse rate (100-140) intermittently. She was prescribed Xanax .25mg prn, and after 2 days admitted and on a holter monitor was sent home being told to quit smoking and gain weight . She had not been eating, c/o either her new dentures hurting too much or stomach spasms causing intense pain (previously seen and treated by rx of Bentyl prn) Hospital intake stated she was cachectic . A follow up MRI of the brain was done as well with the following findings: -cystic changes noted to choroid plexus in trigone region of lateral ventricles -very small foci of cystic encephalomalacia within the basal ganglia and thalami are identified -moderately extensive, patchy and confluent foci of abnormal T2 signal are spread around the periventricular white matter of both cerebral hemispheres, and also noted within the midbrain and pons -scattered paranasal mucoperiostal thickening with no significant sinus opacification Can you PLEASE sum this up? I am a nurse, and while I understand most of this, the doctors where she was treated told her she didn t have a stroke or TIA...or at least that is what my mother came away thinking. However, am I incorrect that what I am seeing is that she has evidence of multiple small, deep, old strokes present, as well as diffuse white matter disease/small vessel disease? I ask because I have seen a marked change in my mom since this began. She becomes angered more easily, jumping on people. She seems to forget things I have told hre just a few days/weeks ago, she exhibits almost manic/depressive type swings, she does not plan well, and she laughs and/or reacts inappropriately. She also has episodes of extreme anxiety and cries uncontrollably saying she can t stop . These all seem to me to be symptoms of Vascular Dementia, no? My Dad was diagnosed with colon cancer this past summer, and I am an only child trying to care for them both...please help me understand these results. I feel she needs further evaluation...