Abstract: The clinical manifestations of neurosyphilis are diverse, including symptoms such as seizures, vertigo, headaches, ptosis, Parkinsonism, ataxia, and limb weakness. Neurosyphilis presenting with ataxia as the initial symptom is often misdiagnosed. Herein, we report a case and analyze its clinical manifestations, neuroimaging features, and cerebrospinal fluid (CSF) characteristics, and the relevant literature was reviewed.

Key words: neurosyphilis, ataxia, first symptom, general paresis