Infection related ischemic stroke presenting as partial locked-in syndrome

Ischemic stroke in young adults have a multiplicity of possible causes making it a diagnostic challenge. Inflammatory and infectious diseases must be considered, alongside the most common etiologies and risk factors. We present a case of a 34-year-old male, with no known vascular risk factors, admitted to a stroke unit with partial locked-in syndrome characterized by quadriplegia and anarthria but with sustained horizontal bilateral gaze, with imaging study showing a pontine acute ischemic lesion. Diagnostic workup revealed a positive serum serology for HIV and Treponema pallidum. Even though cerebrospinal fluid showed negative Treponema pallidum serology, both meningovascular syphilis and HIV vasculopathy were considered potential and/or cumulative causative agents. The patient showed dramatic neurologic improvement after penicillin and antiretroviral treatment were started, as well as intensive physical therapy, being able to ambulate at hospital discharge. The importance of this report rests not only on the rarity of Partial locked-in syndrome and the above-mentioned stroke etiologies but is also an example of the rehabilitation potential of younger adults.