We here report two patients (58-year-old, 77-year-old women) who presented themselves with generalized convulsion, impaired consciousness and hypertension several days after cancer surgery and transfusion. MRI T2 weighted images show an extensive area of increased signal intensity along the occipital cortex, but the underlying white matter revealed slight high signal intensity on diffusion weighted images. Despite similarities of those two cases to posterior leukoencephalopathy syndrome, they differ since the neuroimaging abnormalities are mostly in the occipital cortex. It is likely that the posterior cerebral cortex and white matter are vulnerable to circulatory, vascular and metabolic/toxic impairments. Depending on the abnormalities of many physiological variables, either the subcortical white matter, cortical gray or both might become a major target of this syndrome.