With bilateral frontal demyelination changes, patients may present with affective psychiatric symptoms and may also experience seizures. In mild cases, patients may be free of any clinical signs and symptoms. Most of them are clinically caused by chronic ischemia and hypoxia, which usually occur in middle-aged and elderly people. Hypertensive encephalopathy may be caused if the patient’s blood pressure is usually high and poorly controlled, and may also present with ischemia and hypoxia of the brain. Alternatively, it may be caused by severe hypotension. It can also be caused if the patient has severe hypovolemia. Treatment to improve cerebral metabolism can be given, and commonly used drugs include olanzapine, piracetam, cytarabine, vincristine, and cerebrolysin. Drugs to improve blood circulation, such as salvia, panax ginseng and ginkgo biloba preparations, can also be used, along with active control of the cause.