Objective　To study the clinical features of neurosyphilis patients presented as acute cerebral infarction,and to explore the value of high-resolution magnetic resonance vessel wall imaging (HR-VWI ) in the etiological diagnosis of cerebral infarction.Methods　Seven patients with neurosyphilis presented as acute ischemic stroke were included in this study from January 2018 to September 2022.The clinical characteristics,laboratory examination,and imaging data including HR-VWI were summarized and analyzed.Results　Among seven cases,six patients had multiple atherogenic risk factors,and two tested human immunodeficiency virus (HIV)-seropositive.The most common clinical manifestation was hemiplegia (71.4%),followed by dysarthria (57.1%).Diffusion-weighted magnetic resonance imaging showed high signal lesions more common in the basal ganglia and pons.HR-VWI showed vasculitis changes in infarction-related vessels in six patients,in whom the diagnosis of meningovascular syphilis was considered,while vasculitis change was only shown in one case by MR angiography.Infarct responsible vascular with evidence of atherosclerosis in one case,in whom the diagnosis of large artery atherosclerotic cerebral infarction was considered probable according to the TOAST classification.Conclusion　Clinical features of stroke after neurosyphilis can be indistinguishable from ischemic stroke.HR-VWI can reveal vasculitis of meningovascular syphilis,which is of great value in determining the mechanisms of cerebral infarction in neurosyphilis patients who with multiple atherosclerotic risk factors.