• Davide Bagatti, Jasenka Mazibrada, Gianfranco Kim Innocente Ligarotti, Vittoria Nazzi, and Angelo Franzini.
• Department of Neurosurgery III, Foundation of the "Carlo Besta" Neurological Institute, IRCCS, Milan, Lombardy, Italy. Electronic address: davide.bagatti@libero.it.
• World Neurosurg. 2016 Mar 1; 87: 662.e13-8.

BackgroundAlthough syphilis has become a rare disease in the Western world since the Second World War, it is believed to have infected 12 million people in 1999, with greater than 90% of cases occurring in the developing world. Moreover, since the year 2000, the rates of syphilis have been increasing in the United States, the United Kingdom, Australia, and Europe. Because of the mimic nature of the disease and the overall low rate of occurrence of its manifestations in advanced stages, a proper diagnosis may prove difficult.Case ReportWe report the case of a 41-year-old African man affected by neurosyphilis that manifested itself through a meningovascular chronic inflammatory process, with the peculiar feature of a bilateral aneurysm of probable mycotic origin involving the distal tract of A2 segment of both anterior cerebral arteries.ConclusionsBecause of the mostly nonspecific nature of clinical manifestations of syphilis (particularly advanced syphilis) and its consequent tendency to masquerade as many other diseases, even a skilled physician may find its diagnosis quite challenging; thus, thorough clinical and radiologic investigations should be supported by serologic testing for syphilis in all cases of cognitive impairment. Mycotic intracranial aneurysms in association with neurosyphilis rarely are reported; however, they require early diagnosis and meticulous, individualized treatment. Because syphilis appears to be on the raise, further studies on the topic are warranted.Copyright © 2016 Elsevier Inc. All rights reserved.

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