[Bilateral Medial Medullary Infarction with Meningovascular Neurosyphilis]

Case report A 31-year-old previously healthy man who had sex with men presented with a two-day history of acute-onset dizziness, nausea, and vomiting. On admission, he was afebrile with generalized lymphadenopathy and a truncal and lower-limb rash. Neurological examination revealed no motor weakness or hyperreflexia, but he could not walk unassisted due to dizziness. Brain MRI diffusion-weighted imaging (DWI) showed characteristic V-shaped hyperintense lesions in the bilateral medial medulla (Fig. 1A) and at the pontomedullary junction (Fig. 1B). MR angiography (MRA) showed no stenosis or dissection of the basilar or vertebral arteries (VA) (Fig. 1C).