Pure motor hemiparesis due to pontine infarction as the presenting sign of neurosyphilis

Abstract

A 50-year-old man with minimal risk factors for cerebrovascular disease had a pure motor hemiparesis due to a pontine infarction. Syphilis serology and CSF findings indicated a previously unrecognized meningovascular syphilis as the cause of the stroke. At variance with the majority of recently reported cases, no prodromal syndrome preceded the cerebrovascular event, and there was no HIV coinfection. Treatment with erythromycin and minocycline was followed by clinical improvement and normalization of main CSF parameters including VDRL; oligoclonal bands and local IgG synthesis, however, were still detectable in post-treatment CSF.