感染梅毒合併人類自體免疫不全病毒 (HIV) 的病人可以腦膜炎併顱內血管炎作為最初期 的臨床表現。本文報告一位健康且無慢性疾病的年輕未婚男性，因為急性意識障礙被送醫院 急診接受診治。病人的神經症狀於數小時內急速惡化，緊急腦部影像檢查確診為基底動脈阻 塞致腦幹梗塞。進一步的一系列中風病因檢查包含血清及腦脊髓液檢查結果，最後證實病患 罹神經性梅毒，導致腦膜腦炎併顱內血管炎，此時追加檢驗，同時發現病人已經感染人類自 體免疫不全病毒，雖然臨床無其他的伺機性感染。結論：梗塞性中風可以是神經性梅毒引發 顱內血管炎的初期臨床表徵；年輕中風病患一旦確診罹患神經性梅毒病患，務必特別注意是 否同時合併人類自體免疫不全病毒的感染，才能給予適當及週全的臨床治療。

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. (J Intern Med Taiwan 2015; 26: 227-231)