This is a case in which the diagnosis was for some time uncertain, and in which at one time the condition was almost characteristic of general paralysis. A man æt. 43 years, in a responsible position, had syphilis in 1897, and was treated. In 1898 he began to suffer from headaches on the left side, especially localised in the temporal and posterior parietal regions. On July 22nd he noticed that he had dimness of vision, scintillating scotoma, and developed an attack of Jacksonian epilepsy. The headache disappeared for a while, only to recur again, and on September 18th he had a right brachial aura, “mirror writing” was noticed by him, and ten minutes later he had a second epileptiform attack. He was ordered to Egypt. On November 10th, after temporary motor aphasia, he had a third fit. For the next four months he was pretty well (he was under treatment). On March 23rd, 1899, recurrence of temporary motor aphasia and a fourth fit. June 1st, auditory hallucinations followed by a fifth fit. After this he did not regain health as usual, disorder of speech persisted, and on July 10th he had a sixth fit. He returned to Paris, and four days later (July 14th) had a seventh fit. Ballet and Brissaud then saw him. His speech, twitching of the lips, trembling of the tongue, altered handwriting, unequal pupils—all strongly suggested general paralysis. On July 22nd paresis of the right upper limb occurred. Intra-muscular injections or biniodide of mercury were prescribed; the fits did not recur, and now supervened ocular troubles, which enabled his medical advisers to exclude once for all the diagnosis of general paralysis. Diplopia was followed by strabismus, and on October 15th there was complete paralysis of the sixth nerve on the right side, with slight ptosis of the upper lid and mydriasis. Partial paralysis of the third nerve was also present. There was also noticed right-sided twitching of the eye, slight facial paralysis, and deviation of the uvula to the left. The diagnosis appeared to be clearly cerebral syphilis: arteritis at the base, especially in the circle of Willis, associated with bulbo-pontine lesions.
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