Atypical intracerebral hemorrhage and internal jugular vein thrombosis in meningovascular neurosyphilis

Abstract

A previously healthy 63-year-old man presented with sudden-onset headache and left-sided clumsiness. Computed tomography revealed a linear hematoma extending from the cerebellar vermis to the left cerebellar hemisphere. Brain magnetic resonance imaging revealed an incidental thrombus occlusion of the left internal jugular vein. Based on his history of unprotected sexual intercourse, mild cognitive impairment, laboratory findings, and cerebrospinal fluid tests, he was diagnosed with meningovascular neurosyphilis. Treatment with intravenous penicillin G resulted in the resolution of both hemorrhage and venous thrombosis, emphasizing the need to consider meningovascular neurosyphilis as a differential diagnosis for unexplained hemorrhagic stroke.