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A 39-year-old man developed progressive right middle cerebral artery distribution strokes as a manifestation of meningovascular neurosyphilis. He also had hypertension and smoked cigarettes. He subsequently developed neuropsychiatric symptoms despite appropriate syphilis treatment, prompting further investigation which identified anti-N-methyl-D-aspartate receptor (NMDAR) autoantibodies in the cerebrospinal fluid. The catatonia resolved after high-dose intravenous corticosteroids and plasma exchange for suspected anti-NMDAR encephalitis. This report highlights the importance of diagnostic flexibility and is a further example of postinfective NMDAR encephalitis after infections other than HSV-1 encephalitis.