A young man with a history of two strokes was found to have serologic evidence of a prior syphilitic infection, abnormal spinal fluid, and angiographic evidence of diffuse intracranial and extracranial angiopathy which we believe was due to tertiary syphilis, although his use of oral amphetamines cannot be ruled out as a contributing factor. This is the first reported case in which angiography has demonstrated both intracranial and extracranial disease arterial disease due to neurosyphilis. Since syphilis can produce diffuse cerebral arterial changes, this diagnosis should be considered in young patients with stroke even when non-treponemal serologic tests are negative.