Basilar artery occlusion in a young man related to coinfection of neurosyphilis and human immunodeficiency virus

The meningovascular complication of syphilis and human immunodeficiency virus (HIV) infection is not uncommon. A young man with no atherosclerotic and cardiac risk factors presented with acute brainstem infarct resulting from basilar artery occlusion. His condition deteriorated rapidly despite aggressive antithrombotic therapies. Brain imaging revealed old lacunes in addition to the current brainstem ischemic lesions. The patient was diagnosed to have neurosyphilis and human immunodeficiency virus infection after work-ups. The patient began a gradual neurological improvement after antibiotic treatment and combination antiretroviral therapy. Ischemic stroke can be the first clinical presentation in syphilis and HIV-infected persons. Earlier diagnosis and treatment of the causative infectious disease is important and can provide a better stroke outcome.