Teaching NeuroImage: Vessel Wall MRI Features of Meningovascular Syphilis | Neurology
A 67-year-old man presented with hemifacial weakness and maculopapular rash, treated as Bell palsy. Initial CT angiogram was normal. 6 weeks later, he developed dizziness, diplopia, ataxia, and worsening rash. MRI revealed midbrain, pontine, and thalamic infarcts. An infectious vasculitis was suspected. Vessel wall MRI (VWMR) showed near-occlusion and concentric enhancement of the distal basilar and bilateral P1 PCAs (Figure 1), corroborated with a CT angiogram (Figure 2). His serum syphilis RPR was
