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Neurosyphilis
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“Neurosyphilis (also known as general paresis [or progressive general paralysis]) appears 10 to 15 years after primary infection with Treponema (...) and usually affects the frontal lobes, resulting in personality changes, irritability, and decreased self-care. Grandiose delusions develop in 10 to 20% of affected patients. The disease progresses with the development of dementia and tremor, eventually reaching bed confinement by parous neurosyphilis”5555. Kaplan HI, Sadock BJ, Grebb JA. Compêndio de psiquiatria: ciências do comportamento e psiquiatria clínica. Porto Alegre: Artes Médicas; 1997.. |
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Dementia
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This is a syndrome characterized by multiple impairments in cognitive functions without consciousness impairment. Cognitive functions that may be affected in dementia include general intelligence, learning, and memory, language, problem-solving, orientation, perception, attention and concentration, judgment, and social skills. The patient’s personality is also affected”55. Vascular dementia “is usually the result of cerebral infarctions from vascular diseases, including hypertensive cerebrovascular disease. Infarcts are usually small, but cumulative in their effect”56. Frontotemporal dementia, described only in detail in the last two decades22, is the most common subtype of “frontotemporal dementia”, a category that gathers several diseases that cause damage to the frontal and lateral regions of the brain. |
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Meningioma
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it is a tumor, usually benign and slow-growing, of the meningeal membranes that involve the central nervous system (CNS). According to Sax’s18 hypothesis: “If a meningioma of the right optic nerve were present in this [Nietzsche’s] case, a regular mass size increase would have effectively led to a de facto frontal lobotomy. Such an effect would be responsible for the subsequent deterioration of Nietzsche’s state of mind between 1889 and 1900 [post-collapse]”. |
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CADASIL
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Acronym of “Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy”. It is a hereditary autosomal dominant disease of small and medium blood vessels transmitted by the paternal lineage, whose characteristic is the tetrad dementia, psychiatric disorders, headache and frequent cerebral vascular accidents. This disease causes repeated ischemic attacks and is related to mutations in the NOTCH3 gene. According to Perogamvros et al.26: “Nietzsche evidenced all the major clinical manifestations of CADASIL (young age [< 50 years old], migraine, strokes, mood disorders, subcortical dementia, [paternal] family history)”. |
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MELAS
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acronym of “mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes”. It is a rare, multisystem neurodegenerative disease of maternal transmission, of progressive development and with a very variable clinical phenotype, which usually appears in childhood (usually between 2 and 10 years of age; in rare cases, it may appear later, up to 40 years or even later). Koszka27 concludes his article by stating that “when considering the entire clinical history available on Nietzsche (onset of disease in childhood, maternal inheritance, typical symptoms and complications, disease development) and his family, his probable diagnosis is MELAS syndrome or MELAS overlap syndromes”. |
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MDP/BAD
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Formerly known as “manic-depressive psychosis” (Kraepelin) and reclassified as “bipolar affective disorder” (Leonhard). It is characterized by the cyclic alternation between manic or hypomanic phases (mood exaltation) and depressive phases (mood relegation), interspersed by intermittent periods of complete recovery. Given the lack of a demeaning and deteriorating course55, it may even be used as an explanation for some aspects of Nietzsche’s affective life, but never as a causal criterion for his collapse and consequent ruin, as Cybulska1111. Cybulska EM. The madness of Nietzsche: a misdiagnosis of the millennium? Hosp. Med. 2000; 61(8):571-575. correctly points out. |
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Schizophrenia
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formerly known as “early dementia” (Kraepelin), then renamed as “schizophrenia” (Bleuler48). Its symptomatology covers positive (delusions, hallucinations, language disorders, etc.) and negative (affective dullness, apragmatism, self-neglect, etc.) psychotic symptoms. Depending on the specific subtype, there are predominant positive (paranoid schizophrenia) or negative (hebephrenic schizophrenia and catatonic schizophrenia) symptoms, and these are the most common subtypes in the Nietzsche era. It develops by outbreaks, acute episodes that tend to leave a sequel and – when untreated, as was customary at the turn of the nineteenth to the twentieth century – lead to deterioration of the personality. Among mental disorders, this is the only one that may have acted as a causal factor in the Turin collapse, although the recent advocate of this hypothesis, namely, Schain14, has not specified the subtype in question, more in keeping with the supposedly triggering psychogenic aspects of Nietzsche’s many crises. |
