Multifocal Stroke and Gait Ataxia in the Elderly: A Peculiar Case of Meningovascular Neurosyphilis With Posterior Circulation Infarction

An 83-year-old male presented with a months-long ataxic gait and recent frequent falls. Initial evaluation revealed ventriculomegaly and acute ischemic infarction to the right cerebellar and occipital regions in addition to severe cervical stenosis. Syphilis serology with reflex returned positive, and neurosyphilis was confirmed on cerebrospinal fluid with a reactive Venereal Disease Research Laboratory test, lymphocytic pleocytosis, and elevated protein. The patient was put on a two-week course of intravenous penicillin G while completing inpatient physical rehabilitation and demonstrated significant improvement. This case highlights the importance of considering neurosyphilis as a differential in the elderly with new-onset gait disturbance and first-time stroke without a contributory past medical history. This report underscores the emergence of neurosyphilis in elderly populations and the challenge in correctly identifying cases in this demographic, considering its reputation as a “great imitator” of other neurocognitive disorders.