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An 86-year-old patient with multiple vascular risk factors including 3 previous strokes woke up with a sensation of wet lower limbs, with bilateral loss of proprioception in legs on examination. Cervical MRI showed 2 acute medullary ischemic lesions in the posterior columns at level C3 and C4 (figure 1, A–D). Biological screening including HIV serology, Treponema pallidum hemagglutination assay (TPHA), Venereal Disease Research Laboratory test (VDRL), and Lyme disease serology showed an increased TPHA titer of 1:320, with a negative VDRL.
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