Thanks for writing in to us.
Sorry to hear that you are having a tough time having to care for both parents who been ill for a while. Coming to your mom's ER visits, from the CT scan findings, there is mention of periventricvular white matter
changes due to microvascular disease
and scattered chronic lacunar infarcts are seen in basal ganglia
and external capsules bilaterally. These refer to mini strokes in the past which might have gone unnoticed.
Further, as the CT scan could not be conclusive regarding an underlying acute infarct, a follow up MRI scan was done. As per MRI report there are 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. This also does not pin point to any acute cerebrovascular event.
Your suspicion on possibility of Vascular Dementia
needs imaging and clinical coreelation. One of the most useful tests in the evaluation of Vascular Dementia is magnetic resonance imaging
(MRI). The MRI is very sensitive to changes in the brain caused by stroke. The principal findings in Vascular Dementia are lacunar infarcts (small, spherical strokes in the deep parts of the brain) and abnormal findings in the cerebral white matter. This is the region where axons (the long part of a nerve cell) travel. It is called the "white matter" because the fatty insulation on the axons makes it look white in real life. These changes can be seen in many people who appear to have no cognitive complaints, however, studies have shown that as the total volume of these changes increases, cognitive difficulties are more likely.
Clinically Vascular Dementia needs to be differentiated from Alzheimer's Disease. A Psychiatry consultation and work up will help you further.
Hope this helps