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Review
. 2025 Apr 14;19(1):174.
doi: 10.1186/s13256-025-05090-9.

Ischemic stroke as a presenting feature of neurosyphilis in an immunocompetent adult and attained complete recovery following treatment: a case report and review of the literature

Elsah Tegene Asefa  1 , Tamirat Godebo Woyimo  2 , Yosef Bekele Bonsa  2 , Addisalem Gebre Silase  2
Affiliations
Review

Ischemic stroke as a presenting feature of neurosyphilis in an immunocompetent adult and attained complete recovery following treatment: a case report and review of the literature

Elsah Tegene Asefa et al. J Med Case Rep. .

Abstract

Background: Neurosyphilis typically presents with nonspecific symptoms such as behavioral changes or cognitive impairment, rather than an initial stroke.

Case presentation: This case report describes a Black African man in his thirties who experienced sudden weakness on the left side of his body. Computed tomography suggested a nucleo-capsular ischemic lesion. However, given his young age and lack of traditional stroke risk factors, further investigations were pursued. Laboratory tests revealed positive results for syphilis in both blood and cerebrospinal fluid. Additional imaging (head and neck angiography) indicated intracranial vasculitis with widespread and acute ischemia in the right hemisphere. Treatment with ceftriaxone and aspirin was initiated. Through ongoing monitoring and care, the patient's neurological condition improved.

Conclusion: The case underscores the critical need for prompt diagnosis and comprehensive assessment in patients experiencing stroke-like symptoms, especially in younger individuals. By recognizing neurosyphilis as a potential cause, healthcare providers can initiate timely treatment and improve patient outcomes.

Keywords: Immunocompetent adult; Meningovascular syphilis; Neurosyphilis; Rare; Stroke.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical clearance was obtained from the Institutional Review Board (IRB) of the Institute of Health, Jimma University. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Consent statement: Written informed consent was obtained from the patient before starting the data collection process. The confidentiality and privacy of the patient were assured. Neither the data records nor the extracted data were used for any other purpose. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
An axial view of the non-contrast computed tomography scan showing right lenticular area and caudate nucleus hypodense lesion, as indicated by the arrow
Fig. 2
Fig. 2
Right carotid artery Doppler ultrasound. A–B B-mode transverse view showing echogenic focus in the right internal carotid artery (blue arrow head). B B-mode longitudinal view showing echogenic focus in the right internal carotid artery (blue arrow head). C Color-flow study showing absent luminal color-filling of right internal carotid artery (yellow arrow). R-ICA right internal carotid artery, R-ECA right external carotid artery, R-IJV right internal jugular vein
Fig. 3
Fig. 3
Computed tomography angiography of head and neck. A Coronal view shows significant luminal narrowing of the proximal right internal carotid artery (yellow broken line) with total long-segment occlusion distally involving the rest of the cervical segment (asterisk). B Axial view at the level of cervical segment of right internal carotid artery shows significant caliber narrowing compared with the contralateral left internal carotid artery. RICA/LICA right/left internal carotid artery, RECA right external carotid artery (yellow arrow). A Red arrows with RICA, RECA and LICA and the green arrow (LICA) are included for anatomic demarcations. B RECA with blue arrow was included for anatomic demarcation
See this image and copyright information in PMC

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