The prevalence of poststroke dementia (PSD) varies largely according to the composition of cohorts, setting, and delay after stroke. The cognitive syndrome of vascular dementia (VaD) is characterized by: memory deficit, dysexecutive syndrome, slowed information processing, and mood and personality changes. Cortical VaD relates to large vessel disease, cardiac emboli, and hypoperfusion. It prominently shows cortical and corticosubcortical arterial territorial and distal field infarcts. The occurrence of dementia depends on two factors: the total volume of brain loss because of infarcts and hemorrhages, and the location of these lesions. Many instances of dementia occurring in stroke patients are probably the consequence of the cumulative effect of the cerebrovascular lesions, Alzheimer pathology, and white matter changes. Patients with dementia after stroke are significantly less often treated with aspirin or warfarin than nondemented patients. Trials of secondary prevention of stroke usually exclude patients with obvious dementia.

Acute hypertensive response is the elevation of blood pressure above normal and premorbid values that initially occurs within the first 24 hours of symptom onset in patients with intracerebral hemorrhage (ICH). Hypertension is the most frequent and most important risk factor for ICH. Hypertensive patients suspected of primary intraparenchymal hematoma died and were subsequently autopsied in order to assess the alterations of extraparenchymal and intraparenchymal vascular structures. Stroke patients with a history of hypertension are at risk of critical hypoperfusion for mean arterial pressure levels usually well tolerated by normotensive individuals. Drugs recommended for use in lowering blood pressure in acute stroke include labetalol, hydralazine, nicardipine, and nitroprusside. The Antihypertensive Treatment in Acute Cerebral Hemorrhage (ATACH) trial is a prospective, open label phase I safety and tolerability study started in 2005 that plans to study 60 patients.

An atherosclerotic plaque with specific morphological features is more prone to rupture, and irregular luminal plaque surfaces are more prone to thrombus formation, thromboembolization and consequent acute events. Since computerized tomography angiography (CTA) can accurately grade the severity of carotid luminal stenosis, computerized tomography (CT) is increasingly used in the evaluation of stroke patients. CTA had a high degree of correlation with results of digital subtraction angiography (DSA) in the evaluation of carotid luminal stenosis. The main advantage of multidetector CT (MDCT) for carotid atherosclerotic plaque evaluation is the increased in-plane resolution, the decreased slice thickness and the subsequent ability to obtain near isotropic voxels. In MDCT the reconstructed slice thickness is independent of the detector collimation and is equal to or larger than the single detector collimation. MDCT can assess luminal surface morphology with the same or better accuracy than DSA.

Diffusion-weighted MR imaging (DWI) is a technique in which microscopic water motion is responsible for the contrast within the image. Diffusion of water molecules alters conventional T1- and T2-weighted MR imaging, because it induces a signal dephasing and a signal loss. Clinical practice uses different representations of the results of DWI data processing: diffusion weighted images, DWI trace and ADC maps, which are all equivalent. DWI is more accurate than CT in localizing ischemic lesions shortly after stroke onset. DWI can show small lesions adjacent to the cerebrospinal fluid. The NINDS and ECASS studies have demonstrated an increased risk of hemorrhagic transformation in stroke patients with a large area of hypodensity on admission CT when treated with thrombolytic therapy. DWI affords accurate localization of strokes. Finally, DWI can more frequently differentiate a small deep subcortical infarct from a cortical or a combined cortical/subcortical lesion than conventional MR imaging can.