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Clinical Case A 49-year-old man presented with confusion, global aphasia, right-sided motor seizures, hemiparesis and neglect, following a 6-month prodrome of weight loss, personality change and an episode of transient expressive aphasia. He was afebrile. Routine bloods, body imaging (CT and PET), HIV testing and autoantibodies were normal. EEG revealed left hemisphere seizures that resolved with anti-seizure medications. MRI demonstrated left-hemispheric T2 and FLAIR hyperintensity, oedema, diffuse leptomeningeal and parenchymal enhancement, consistent with meningoencephalitis. CSF analysis found TPHA positivity, WCC 7, protein 0.77g/L and positive oligoclonal bands. They were treated with 14 days IV benzylpenicillin and ceftriaxone. Hemiparesis resolved, but bilateral bradykinesia, hypokinesia and polyminimyoclonus emerged thereafter. Language memory and executive functions improved, although deficits remain. Repeat CSF examination will be necessary to ensure adequate treatment.Conclusion Venereal syphilis is due to Treponema pallidum infection, with a late-chronic paretic form, seen in this case, developing following CNS infiltration of spirochaetes via Virchow-Robin spaces. Neurosyphilis may manifest in many forms, with varying clinical presentation and wide-ranging radiological findings. Neurosyphilis has not vanished, global syphilis cases are rising, and as such testing should be routine in Neurology.ellieoberstein@gmail.com