The problem of diagnosis and treatment of the meningovascular form of neurosyphilis in neurology and clinical pharmacology has been actively discussed for over a hundred years. Invasion of pale treponema in the central nervous system occurs in the early stages of the course of syphilitic infection during the period of hematogenic dissemination of the pathogen by perforation of the vascular endothelium. With the discovery of penicillin, which is still the “standard” of syphilis treatment, neurosyphilis has become a fairly rare disease, and therefore difficulties may arise in its diagnosis. The initial phase of infection may be accompanied by an asymptomatic meningeal reaction. The article presents a clinical observation of neurosyphilis manifested by epileptic seizures and extensive ischemic stroke.