VZV vasculitis may present with large and small artery strokes in the context of arterial luminal irregularities, beading, or stenosis.710,711 Patients in whom VZV vasculitis is suspected should undergo a lumbar puncture for anti-VZV immunoglobulin G, immunoglobulin M, and polymerase chain reaction. Anti-VZV immunoglobulin G has the highest sen- sitivity of the 3 tests. A negative VZV polymerase chain reaction does not rule out VZV vasculitis.712,713 If suspicion of VZV vasculitis is high, it may be rea- sonable to treat empirically while awaiting the results of confirmatory tests. Acyclovir is the drug of choice for the treatment of VZV infection.714 Among patients with stroke and diagnosed neurosyphilis, intense treatment with penicillin G is mandated.735 In some instances, there may be coexisting comorbidities that may also predispose to stroke such as large artery atherosclerosis or AF. In such cases, treating neuro- syphilis is still indicated in addition to the confounding competing risk of stroke. Testing for HIV is indicated in patients with stroke and diagnosis of neurosyphilis. This recommendation is supported by a relatively high coexistence (5% 16%) of both sexually transmitted 2. Secondary stroke prevention among patients with HIV vasculopathy is focused on daily anti- platelets and treatment aimed at restoring the CD4 counts and immune system. There are no randomized data to support these claims. Restoring the immune system as captured by the CD4 count is indicated in all patients with HIV regardless of whether they have stroke.717 CLINICAL STATEMENTS AND GUIDELINES Kleindorfer The presence of stroke may be seen as an even greater indication to treat the most devastating consequences of HIV infection and associated immunosuppression. 