This chapter presents a case of a 67-year-old right-handed woman with a history of a 3 cm mid left parietal lobe intra-cerebral hemorrhage (ICH) of uncertain etiology admitted to the inpatient neurology service after an acute episode of witnessed productive aphasia and inability to obey commands during an outpatient neurology assessment. Cognitive history indicates that she has noticed minor deficits of short-term memory and word finding since her stroke, but denied any functional deficits associated with her cognition. The patient was started on citalopram with the goal of improving her initiative and a cholinesterase inhibitor for her vascular cognitive impairment (VCI). A trial of cholinesterase inhibitor with measurable outcomes identified at the outset is reasonable, particularly since a neurodegenerative process cannot be ruled out as a contributing factor. Ongoing partial seizures may contribute to cognitive impairment. This patient's lamotrigine should be titrated to minimize future seizures.