Background: Moyamoya disease is an uncommon cerebrovascular disorder. There is speculation that syphilis may induce Moyamoya disease; however, literature on this association is sparse.
Case Report: We describe the case of a 43-year-old female with syphilis who experienced three ischemic strokes. Angiography revealed a “puff of smoke” pattern, diagnostic of Moyamoya. The patient underwent antiplatelet therapy following antibiotic treatment for syphilis. Despite conservative management, there was no clinical improvement. Consequently, the patient was referred for neurosurgical intervention and underwent burr hole surgery to treat Moyamoya disease.
Conclusion: There are no definitive conclusions regarding whether the patient’s primary complaints stem from syphilis or Moyamoya disease. To our knowledge, this case represents the second instance where Moyamoya disease and syphilis have been reported concurrently. This case suggests that syphilis should be considered as a potential factor in patients presenting with Moyamoya disease.