Pachymeningitis luetica is extremely rare in developed countries. We descri
be a 41-year-old male patient with pachymeningitis luetica, multiple ischae
mic infarctions, and severe hydrocephalus. The delay in making the diagnosi
s contributed to patient's death. Rapid diagnosis is essential on the sligh
test suspicion of an infection by Treponema pallidum, because timely treatm
ent with antibiotics is effective. (C) 2000 Elsevier Science B.V. All right
s reserved.