Pseudoxanthoma elasticum (PXE) is an inherited connective tissue disorder, characterized predominantly by skin, eye, cardiac, and vascular abnormalities. The genetic defect has been mapped to the ABCC6 gene on chromosome 16. The most characteristic and diagnostic feature of PXE is the angioid streaks found in the retina. The streaks are red-brown or gray, are usually wider than veins, and radiate from the optic disc. Abdominal angina and ischemic bowel disease occasionally develop. Hypertension is also very common in patients with PXE and often contributes to the cardiac and cerebrovascular pathology leading to strokes. Premature occlusive cervicocranial disease and aneurysmal subarachnoid hemorrhage are the two cerebrovascular problems directly attributable to PXE. It is difficult in patients with Binswanger-like abnormalities, PXE, and hypertension to know how much of the abnormalities, if any, relate directly to PXE and how much are attributable to the hypertension.