Paul Bouts and the Short Life of Psychognomy in Brazil.

Paul Bouts (1900-1999) was a Belgian pedagogue, a Roman Catholic priest, and the founder of Psychognomy, which is a personality diagnostic system combining phrenology and several related practices - typology, craniofacial measurements, physiognomy, graphology etc. Bouts had a fragile health; therefore, it is unlikely that he travelled to Brazil. Despite this, his most famous book, rich in conservative and religious thoughts, was translated to Portuguese and published with ecclesiastic support in 1943, and the doctrine acquired good reputation among Brazilian members of the clergy, politicians, teachers, and military personnel. Lay scholars and medical doctors founded a Brazilian institute devoted to the study and diffusion of psychognomy in 1949. They published two volumes of a psychognomy treatise, and the institute was active until the early 1960s, when social interest in the subject rapidly vanished.

Paul Bouts (1900­1999) foi um pedagogo e padre católico belga que criou a psicognomia, um sistema de análise caracterológica que combinava elementos da frenologia, tipologia, medições craniofaciais, fisionomia, grafologia etc. Suas teorias influenciaram acadêmicos, religiosos, políticos e militares brasileiros. Bouts tinha uma saúde frágil, e não há evidências de que tenha estado no Brasil. Seu livro mais famoso, Psicognomia, foi publicado no país em 1943 com aval da censura eclesiástica e com apêndices especiais. A doutrina levou, ainda, à criação, em 1949, de um instituto privado de divulgação e estudos de psicognomia com sede no Rio de Janeiro, que publicou dois volumes de um tratado sobre o tema e permaneceu ativo até o início da década de 1960, quando o interesse pelo assunto rapidamente desapareceu na sociedade.

Paul Bouts and the Short Life of Psychognomy in Brazil / Paul Bouts e a curta vida da psicognomia no Brasil

Abstract Paul Bouts (1900-1999) was a Belgian pedagogue, a Roman Catholic priest, and the founder of Psychognomy, which is a personality diagnostic system combining phrenology and several related practices - typology, craniofacial measurements, physiognomy, graphology etc. Bouts had a fragile health; therefore, it is unlikely that he travelled to Brazil. Despite this, his most famous book, rich in conservative and religious thoughts, was translated to Portuguese and published with ecclesiastic support in 1943, and the doctrine acquired good reputation among Brazilian members of the clergy, politicians, teachers, and military personnel. Lay scholars and medical doctors founded a Brazilian institute devoted to the study and diffusion of psychognomy in 1949. They published two volumes of a psychognomy treatise, and the institute was active until the early 1960s, when social interest in the subject rapidly vanished.

Resumo Paul Bouts (1900-1999) foi um pedagogo e padre católico belga que criou a psicognomia, um sistema de análise caracterológica que combinava elementos da frenologia, tipologia, medições craniofaciais, fisionomia, grafologia etc. Suas teorias influenciaram acadêmicos, religiosos, políticos e militares brasileiros. Bouts tinha uma saúde frágil, e não há evidências de que tenha estado no Brasil. Seu livro mais famoso, Psicognomia, foi publicado no país em 1943 com aval da censura eclesiástica e com apêndices especiais. A doutrina levou, ainda, à criação, em 1949, de um instituto privado de divulgação e estudos de psicognomia com sede no Rio de Janeiro, que publicou dois volumes de um tratado sobre o tema e permaneceu ativo até o início da década de 1960, quando o interesse pelo assunto rapidamente desapareceu na sociedade.

Prevalence of mouth breathing, with or without nasal obstruction, in children with moderate to severe obstructive sleep apnea.

BACKGROUND: Mouth breathing (MB) is a symptom of obstructive sleep apnea (OSA) in children, but its diagnosis remains challenging. The main objectives of our study were to evaluate whether parents' and physician's diagnose of MB were concordant and to evaluate the prevalence of nasal obstruction in children with OSA and MB. METHODS: Ninety-three children (median age: 10.6 years, range 3-18) with moderate to severe OSA prospectively underwent otorhinolaryngologist (endoscopy, acoustic rhinometry and pharyngometry allowing calculation of pharyngeal compliance) and orthodontist (clinical exam and cephalometry) assessments together with parental interview (daytime MB: never, sometimes, often, always). MB was also assessed by the otorhinolaryngologist (nasal obstruction on endoscopy) and the orthodontist (incompetent lips or anterior open bite or low tongue position). RESULTS: Thirty-eight children (41%) were mouth (parental criterion: MB often or always, median age 8.2 years) and 55 nasal (11.4 years, p = 0.016) breathers. The agreement of parental and physician diagnosis of MB was slight (orthodontist) to moderate (otorhinolaryngologist). Parental diagnosis of MB was associated with nasal obstruction on acoustic rhinometry and endoscopy (hypertrophy of inferior turbinate, n = 18 or adenoids, n = 15) and with an adenoid facies (increased Frankfort's mandibular plane angle on cephalometry). Eleven children had MB by habit and were characterized by more severe OSA and higher pharyngeal compliance than mouth breathers with nasal obstruction. CONCLUSION: MB diagnosis by parents is acceptable and is mainly related to nasal obstruction. A subset of children had MB by habit associated with worst OSA and increased pharyngeal compliance that could benefit from myofunctional therapy.

Effectiveness of nutritional interventions to prevent nonprogressive congenital and perinatal brain injuries: a systematic review and meta-analysis of randomized trials.

CONTEXT: Nutritional interventions for newborns with brain injury are scarce, and there are gaps in the knowledge of their mechanisms of action in preventing the occurrence of cerebral palsy (CP) or the incidence of other developmental disabilities. OBJECTIVE: The objective of this review was to assess the effect of nutritional interventions in preventing nonprogressive congenital or perinatal brain injuries, or in improving outcomes related to neurological development. DATA SOURCES: Randomized trials on any nutritional intervention for pregnant women at risk of preterm delivery, or for children with low birth weight, preterm, or with confirmed or suspected microcephaly, CP, or fetal alcohol syndrome disorders (FASDs) were retrieved from MEDLINE, Embase, Scopus, Web of Science, LILACS, and CENTRAL databases from inception to September 17, 2020. DATA EXTRACTION: Data extraction, risk of bias (Cochrane Risk of Bias tool 2), and quality of evidence (GRADE approach) were assessed by 2 authors. DATA ANALYSIS: Pooled risk ratios (RRs) with 95% confidence intervals were calculated using a random-effects meta-analysis. Seventeen studies were included on intravenous interventions (magnesium sulfate [n = 5], amino acids [n = 4], vitamin A [n = 1], and N-acetylcysteine [n = 1]); enteral interventions (vitamin D [n = 1], prebiotic [n = 1], nutrient-enriched formula [n = 1], and speed of increasing milk feeds [n = 1]); and oral interventions (choline [n = 1] and docosahexaenoic acid, choline, and uridine monophosphate [n = 1]). All studies assessed CP, except 1 on FASDs. Eight studies were judged as having high risk of bias. Five studies (7413 babies) with high-quality evidence demonstrated decreased risk of childhood CP (RR = 0.68, 95% CI: 0.52-0.88) with magnesium sulfate. Interventions with amino acids had no effect on CP prevention or other outcomes. Except for 1 study, no other intervention decreased the risk of CP or FASDs. CONCLUSION: Although different types of nutritional interventions were found, only those with antenatal magnesium sulfate were effective in decreasing CP risk in preterm infants. Well-designed, adequately powered randomized clinical trials are required.

Detection of genetic variation and base modifications at base-pair resolution on both DNA and RNA.

Accurate decoding of nucleic acid variation is critical to understand the complexity and regulation of genome function. Here we use a single-molecule magnetic tweezer (MT) platform to identify sequence variation and map a range of important epigenetic base modifications with high sensitivity, specificity, and precision in the same single molecules of DNA or RNA. We have also developed a highly specific amplification-free CRISPR-Cas enrichment strategy to isolate genomic regions from native DNA. We demonstrate enrichment of DNA from both E. coli and the FMR1 5'UTR coming from cells derived from a Fragile X carrier. From these kilobase-length enriched molecules we could characterize the differential levels of adenine and cytosine base modifications on E. coli, and the repeat expansion length and methylation status of FMR1. Together these results demonstrate that our platform can detect a variety of genetic, epigenetic, and base modification changes concomitantly within the same single molecules.

Endovascular closure of patent foramen ovale: a critical appraisal of published trials.

OBJECTIVE: The treatment of cryptogenic stroke patients with a patent foramen ovale (PFO) is controversial. A critical review of these studies is presented. METHODS: A description of all trials comparing medical and endovascular treatment with closing devices is given. Additional pertinent studies are discussed to help construct a rational basis for treatment decisions. RESULTS: Initial negative trials evaluating PFO closure were followed by positive studies published in 2017 and 2018. All trials evaluated young patients (up to 60 years). Methodological problems are present in all trials including their open label construction. Most positive trials developed strategies to increase the percentage of patients with interatrial septal aneurysms or hypermobility and large right-to-left shunts. Even in these positive trials, large numbers of patients need to be treated to avoid one stroke. Atrial fibrillation occurred in 2-6% and other adverse effects related to the procedure and to the devices occurred in a substantial number of patients. Incomplete occlusion of the PFO is also frequent. Anticoagulant treatment has not been adequately studied as a therapeutic option. CONCLUSION: Young patients with cryptogenic strokes seem to benefit from endovascular closure of a PFO in the presence of a large right-to-left shunt or an associated atrial septum aneurysm. For most other patients, a highly-individualized decision must be made, taking into account the low risk of recurrence in patients with a cryptogenic stroke attributable to a PFO, the high numbers needed to treat and the risks related to the procedure.

Endovascular closure of patent foramen ovale: a critical appraisal of published trials / Fechamento endovascular do forame oval patente: análise crítica dos estudos publicados

ABSTRACT The treatment of cryptogenic stroke patients with a patent foramen ovale (PFO) is controversial. A critical review of these studies is presented. Methods A description of all trials comparing medical and endovascular treatment with closing devices is given. Additional pertinent studies are discussed to help construct a rational basis for treatment decisions. Results Initial negative trials evaluating PFO closure were followed by positive studies published in 2017 and 2018. All trials evaluated young patients (up to 60 years). Methodological problems are present in all trials including their open label construction. Most positive trials developed strategies to increase the percentage of patients with interatrial septal aneurysms or hypermobility and large right-to-left shunts. Even in these positive trials, large numbers of patients need to be treated to avoid one stroke. Atrial fibrillation occurred in 2-6% and other adverse effects related to the procedure and to the devices occurred in a substantial number of patients. Incomplete occlusion of the PFO is also frequent. Anticoagulant treatment has not been adequately studied as a therapeutic option. Conclusion Young patients with cryptogenic strokes seem to benefit from endovascular closure of a PFO in the presence of a large right-to-left shunt or an associated atrial septum aneurysm. For most other patients, a highly-individualized decision must be made, taking into account the low risk of recurrence in patients with a cryptogenic stroke attributable to a PFO, the high numbers needed to treat and the risks related to the procedure.

RESUMO O tratamento de pacientes com infarto cerebral criptogênico e forame oval patente (FOP) é controverso. Uma revisão crítica destes estudos é apresentada. Métodos São descritos em detalhes os estudos comparando tratamento médico com o uso de próteses de oclusão do FOP após infarto cerebral. Discutem-se outros estudos pertinentes para ajudar na tomada racional de decisões terapêuticas individualizadas. Resultados Estudos iniciais avaliando fechamento endovascular com próteses foram negativos, porém seguidos de outros estudos com resultados positivos em 2017 e 2018. Somente pacientes até 60 anos foram estudados. Os estudos apresentam vários problemas metodológicos, incluindo sua natureza aberta. A maioria dos estudos positivos desenvolveu estratégias para aumentar o percentual de pacientes com risco aumentado de recorrência, especificamente grandes shunts direita-esquerda e aneurismas/hipermobilidade do septo interatrial. Mesmo estes estudos positivos revelaram um alto NNT (número de pacientes tratados para evitar um evento de desfecho). Fibrilação atrial ocorreu em 2-6 % dos pacientes tratados. Outras complicações relacionadas ao procedimento e às endopróteses e ainda fechamento incompleto do FOP foram também frequentes. Anticoagulantes poderiam constituir estratégia alternativa de tratamento clínico, mas não foram adequadamente estudados. Conclusão Pacientes jovens com infartos criptogênicos parecem beneficiar-se de oclusão endovascular do FOP na presença de grandes shunts e principalmente aneurismas ou hipermobilidade de septo interatrial. Para a maioria dos outros pacientes, uma decisão altamente individualizada deve ser tomada, considerando o baixo risco de recorrência dos infartos atribuíveis ao FOP, o ato NNT e os riscos inerentes ao procedimento.

Lampião, Lages, Lombroso: the autopsy of the bandit king of the Brazilian backlands.

Lampião, the most infamous Brazilian brigand leader, was killed and decapitated during an ambush in 1938. The Alagoas police coroner, Dr. José Lages Filho, performed an autopsy of his head. Strongly biased toward the anthropologic ideas of the famous Italian psychiatrist and criminalist Cesare Lombroso, the examination found only a few of the so-called criminal inborn traits. The Lombrosian doctrine and a number of related theories strongly influenced medical and political reasoning in the first half of the 20th century. Modern genetic and neuroscientific studies are still looking for the potential biological roots of misbehavior and criminality.

Lampião, Lages, Lombroso: the autopsy of the bandit king of the Brazilian backlands / Lampião, Lages, Lombroso: a autópsia do Rei do Cangaço

ABSTRACT Lampião, the most infamous Brazilian brigand leader, was killed and decapitated during an ambush in 1938. The Alagoas police coroner, Dr. José Lages Filho, performed an autopsy of his head. Strongly biased toward the anthropologic ideas of the famous Italian psychiatrist and criminalist Cesare Lombroso, the examination found only a few of the so-called criminal inborn traits. The Lombrosian doctrine and a number of related theories strongly influenced medical and political reasoning in the first half of the 20th century. Modern genetic and neuroscientific studies are still looking for the potential biological roots of misbehavior and criminality.

RESUMO Lampião foi o líder cangaceiro mais famoso do Brasil. Foi morto e decapitado após emboscada em 1938. O Dr. José Lages Filho, perito médico-legal da polícia de Alagoas, realizou a autópsia parcial, restrita à cabeça. O exame focalizou essencialmente a busca de traços físicos característicos do chamado criminoso nato, de acordo com a teoria antropológica criminal desenvolvida pelo psiquiatra italiano Cesare Lombroso. A doutrina de Lombroso e outras com ela relacionadas influenciaram fortemente o raciocínio médico e político na primeira metade do século 20. Seus ecos são ainda hoje perceptíveis em estudos genéticos e neurocientíficos contemporâneos, que seguem procurando as raízes biológicas dos desvios comportamentais e da criminalidade.

New surgical method of tongue reduction for macroglossia: technical note.

OBJECTIVE: We describe here a new surgical technique, which allows for efficient tongue reduction with satisfactory appearance and avoids the complications of tip excision. STUDY DESIGN: This is a retrospective case review that includes 6 patients who had macroglossia and underwent tongue reduction using our new central V-shaped excision technique. Three patients were operated on at an early age because of significant macroglossia with permanent tongue protrusion, cosmetic disorder, and speech delay. The other 3 patients underwent surgery performed in their teenage years because medical treatment had been unsuccessful. We assessed tongue shape, mobility, taste, and sensitivity. RESULTS: The postoperative follow-up period ranged from 2 months to 16 years (average 7 years). On subjective evaluation, all patients were satisfied with the appearance of the tongue and reported no sensitive or sensory difficulties. The patients reported normal food progression in the oral cavity. Objective evaluation showed that the tongue had normal mobility, taste, and sensitivity. Postoperatively, there was no residual tongue protrusion, cosmetic disorder, or speech delay. None of the patients needed revision surgery. CONCLUSIONS: This central V-shaped excision offers good surgical results, with efficient tongue reduction and none of the complications of other tongue reduction techniques, such as tip amputation or anterior wedge resection.

Remoras and spontaneous echocardiographic contrast / Remoras e contraste ecocardiográfico espontâneo

The term "Remora" (hindrance) ­ re (again)/mora (delay) -originally designated a family of fishes ­ the suckerfishes. In ancient Greece and Rome and up to the early 19th century, these fishes were believed to slow down ships by attaching to them. Medicine adopted the term "remora" to describe fluid/blood stasis. Intracardiac blood stasis, or remora, especially in the left atrial appendage, is associated with thrombogenesis and responsible for cardioembolic phenomena. The slow and swirling movement of blood causes the appearance of spontaneous echocardiographic contrast (SEC). I briefly narrate the Naval Battle of Actium, whose result was mythically attributed to the remora fishes, and make a short review of remoras. I also describe Laennec's discussion about intracardiac blood stasis and give a short account of SEC, its original descriptions and importance

Seneca and the First Description of Anton Syndrome.

Seneca was a Roman philosopher, politician, and mentor to the young Nero. He later fell in disgrace and was sentenced to death by the Emperor. Seneca left many texts, one of the most influential being his Moral Letters to Lucilius (63 CE). In Letter 50, he describes the case of Harpaste, his wife's foolish slave who acutely became blind. She denied her illness and argued irrationally about room darkness, constantly asking attendants to change her quarters. Harpaste's case, consisting of acutely acquired blindness and anosognosia in the presence of relatively well-preserved cognition, fulfills the clinical criteria for the diagnosis of Anton syndrome, and probably constitutes its first description.

Phrenology and the Rwandan Genocide.

Belgian colonizers used phrenology to create an irreducible division between the two major groups living for centuries in Rwanda-Urundi. This formed the basis for the implementation of systematic efforts to subdue the large Hutu population. Both the Hutus and the smaller, and initially privileged, Tutsi group soon incorporated the racist discourse, which was pivotal to the gradual increase in violence before and after Rwandan independence in 1962. The Rwandan genocide in 1994 culminated in the horrible pinnacle of this process, involving recurrent episodes of slaughtering. Doctors should not underestimate the racist potential of pseudoscientific misconceptions.

Phrenology and the Rwandan Genocide / Frenologia e o Genocídio de Ruanda

ABSTRACT Belgian colonizers used phrenology to create an irreducible division between the two major groups living for centuries in Rwanda-Urundi. This formed the basis for the implementation of systematic efforts to subdue the large Hutu population. Both the Hutus and the smaller, and initially privileged, Tutsi group soon incorporated the racist discourse, which was pivotal to the gradual increase in violence before and after Rwandan independence in 1962. The Rwandan genocide in 1994 culminated in the horrible pinnacle of this process, involving recurrent episodes of slaughtering. Doctors should not underestimate the racist potential of pseudoscientific misconceptions.

RESUMO Os colonizadores belgas usaram a frenologia para criar uma divisão irredutível entre os dois maiores grupos populacionais vivendo há séculos em Ruanda-Urundi. Isso criou as bases para a implementação de esforços sistemáticos para subjugar a grande população Hutu. Tanto os Hutu quanto o grupo menor e inicialmente privilegiado dos Tutsi logo incorporaram o discurso racista, que foi crucial no aumento gradual da violência antes e após a independência de Ruanda em 1962. O genocídio de 1994 constituiu o terrível ápice deste processo envolvendo massacres repetidos. Os médicos não devem subestimar o potencial racista e discriminatório de falsas concepções pseudocientíficas.

As diferentes manifestações da heminegligência e sua avaliação clínica / The different manifestations of hemineglect and his clinical evaluation

A heminegligência é caracterizada por comprometimento cognitivo basicamente atencional e está relacionada com pior prognóstico evolutivo. Ela pode ser classificada como heminegligência motora, sensorial, e representacional, ou ainda como peripessoal ou extrapessoal. Sua detecção e avaliação podem ser complexas. A heminegligência é geralmente avaliada por uma variedade de testes de "lápis e papel" que nem sempre avaliam todas as manifestações da síndrome. Assim, o uso de uma bateria de testes é preconizado para uma maior sensibilidade diagnóstica. Somente através de avaliação minuciosa podem-se traçar estratégias de tratamento direcionadas e mais eficazes para cada tipo de heminegligência, e assim, melhorar o prognóstico dos pacientes. Testes quedemonstraram validade, sensibilidade e que foram publicados com valor de corte são sugeridos nessa revisão para melhorar a sensibilidade do diagnóstico e facilitar o exame dos profissionais envolvidos na reabilitação dos pacientes. (AU)

Hemineglect is characterized by a cognitive disorder (attentional) and is related to worse prognosis. Hemineglect may be classified as motor, sensory, and representational, as well as peri-personal or extra-personal. Its detection and assessment can be complex. Hemineglect is usually assessed by a variety of "pencil and paper" tests, even if these tests do not assess all manifestations of the syndrome. Therefore,the use of a battery is recommended. This improves diagnostic sensitivity and specificity. Only through specific assessment can more efficient and targeted strategies of treatment be implemented, improving patients? prognosis. Tests that have shown validity, sensitivity and were published with cut-off scores are suggested in this review to improve the sensitivity of diagnosis and to facilitate the examination by professionals involved in rehabilitation. (AU)

Evolving story: trepanation and self-trepanation to enhance brain function.

Trepanation has been performed by people interested in enhancing mental power and well-being since the early 1960s. The pioneers and main proponents of the procedure are described here. The phenomenon appeared in Europe after a Dutch former medical student published a psychoactive drug-friendly scroll suggesting trepanation as a form of permanently increasing cerebral blood volume and function. He trepanned himself in 1965. Three of his friends became enthusiasts. They also submitted themselves to the procedure and published films and books describing their experiences. Two of them coauthored papers, in collaboration with Russian researchers, and created institutions to promote discussion on trepanation. One of these institutions organized trips to Central and South America to get the operation done. Dozens of people nowadays look for trepanation as a method of spiritualization and increasing well-being and mental power. The phenomenon has an uncertain future, however, as the main proponents and supporters are aging.

Evolving story: trepanation and self-trepanation to enhance brain function / Uma história em andamento: trepanação e auto-trepanação para aumentar a função cerebral

ABSTRACT Trepanation has been performed by people interested in enhancing mental power and well-being since the early 1960s. The pioneers and main proponents of the procedure are described here. The phenomenon appeared in Europe after a Dutch former medical student published a psychoactive drug-friendly scroll suggesting trepanation as a form of permanently increasing cerebral blood volume and function. He trepanned himself in 1965. Three of his friends became enthusiasts. They also submitted themselves to the procedure and published films and books describing their experiences. Two of them coauthored papers, in collaboration with Russian researchers, and created institutions to promote discussion on trepanation. One of these institutions organized trips to Central and South America to get the operation done. Dozens of people nowadays look for trepanation as a method of spiritualization and increasing well-being and mental power. The phenomenon has an uncertain future, however, as the main proponents and supporters are aging.

RESUMO Trepanação vem sendo feita por pessoas em busca de aumento da capacidade mental e bem estar desde a década de 1960. Os pioneiros e maiores proponentes do procedimento são aqui descritos. O fenômeno surgiu na Europa estimulado pela publicação de um manuscrito psicodélico e pela auto-trepanação feita por um ex-aluno de Medicina holandês, já falecido. Três amigos se tornaram entusiastas e também se submeteram a trepanação, apresentando o procedimento e descrevendo seus efeitos em livros ou filmes de certa repercussão. Dois deles criaram organizações de difusão e discussão sobre o tema, e uma destas instituições agencia e organiza viagens a países da América Central e do Sul para interessados. Trepanação foi feita até aqui com estes propósitos em dúzias de pessoas. O fenômeno tem, porém, futuro incerto, dado o envelhecimento de seus principais entusiastas.

Furious Frederich: Nietzsche’s neurosyphilis diagnosis and new hypotheses / Frederico Furioso: O diagnóstico de neurossífilis de Nietzsche e novas hipóteses

The causes of Friedrich Nietzsche’s mental breakdown in early 1889 and of the subsequent slow decay to end-stage dementia along ten years will possibly remain open to debate. The diagnosis of syphilitic dementia paralytica, based only on medical anamnesis and physical examination, was considered indisputable by Otto Binswanger. On the other hand, taking into account recently described diseases, selectively collected evidence lend some support to alternative hypotheses: basal forebrain meningioma, CADASIL, MELAS and frontotemporal dementia.

As causas da crise neuropsiquiátrica de Friedrich Nietzsche no início de 1889 e de sua lenta deterioração em demência avançada ao longo de 10 anos provavelmente permanecerão uma questão em aberto. O diagnóstico da época, demência paralítica sifilítica, foi considerado por Otto Binswanger como indiscutível. Por outro lado, em vista de novas doenças descritas, evidências seletivamente ordenadas sugerem diversas hipóteses alternativas propostas ao longo das últimas décadas, como meningioma frontal, CADASIL, MELAS e demência frontotemporal.

Furious Frederich: Nietzsche's neurosyphilis diagnosis and new hypotheses.

The causes of Friedrich Nietzsche's mental breakdown in early 1889 and of the subsequent slow decay to end-stage dementia along ten years will possibly remain open to debate. The diagnosis of syphilitic dementia paralytica, based only on medical anamnesis and physical examination, was considered indisputable by Otto Binswanger. On the other hand, taking into account recently described diseases, selectively collected evidence lend some support to alternative hypotheses: basal forebrain meningioma, CADASIL, MELAS and frontotemporal dementia.