Abstract : Syphilis is a great imitator disease, presents with protean clinical manifestations which mimics other diseases. Neurosyphilis is a major complication of syphilis, it can occur at any stage of the disease with serious neurological and psychiatric manifestations. Over the years the clinical presentation of neurosyphilis has changed with psychiatric and neurocognitive symptoms being predominant. In the present retrospective study clinico-microbiological observations of 15 patients diagnosed to have Neurosyphilis on the basis of cerebrospinal fluid examination by Venereal Disease Research Laboratory test and Treponema pallidum hemagglutination over a period of three years were reviewed. The prevalence of neurosyphilis among syphilis patients was 41.66%. Male (86.67 %) predominance was observed in the study. Neuropsychiatry presentation [11(73.33%)] was the predominant followed by myelopathic [3(20%)] and meningovascular [1(6.66%)]. All the neuropsychiatry cases presented with complaints of behavioural changes, depression, mania and dementia. Human immunodeficiency virus co‑infection was noted in three (20%) patients. Diffuse Cortical atrophy on MR imaging was the predominant observation among 13 (86.66%) patients. On Cerebrospinal fluid examination analysis the median protein level was 75 mg/dl and CSF lymphocyte cell count > 5 cell/L was noted in 11 (73.33%) patients. Neuropsychiatric form was the most common neurosyphilis presentation followed by myelitic and meningovascular in the present study. Diffuse cortical atrophy was the common feature on MR imaging. Atypical forms are now the most common presentation which poses great challenge in diagnosis. High index of suspicion, early diagnosis and prompt treatment can alone decrease the disease burden.