The patient had a very severe attack of migraine (?) yesterday, preceded and accompanied by paraphasia, so severe that for three hours she was unable to make herself understood, and indeed felt “as if her ideas were getting away from her.” This attack was ushered in by a numbness of the forefinger and thumb of the right hand, which lasted for about three hours, though the earlier attacks had lasted for only about ten minutes. During this period the hand felt as if it had been frozen and the loss of muscular power was so great that she was unable to hold objects in the hand. In some of the attacks this paræsthesia has affected the entire left half of the body, and occasionally the right half. Sometimes the seizures come on with great suddenness, so that once, when she was attacked while in the middle of the street, she had considerable difficulty in reaching the sidewalk. After the worst part of the attack is over a certain amount of paraphasia may persist for some days, together with awkwardness in the use of the right hand and numbness. She has had a great deal of nausea and vomiting, without reference to the taking of food.[2] Bearing in mind the mingling of structural with functional symptoms in this case, let us consider the autopsy findings. =ANATOMICAL= =FORMS OF NEUROSYPHILIS= AUTONOMIC (SYMPATHETIC) NEUROSYPHILIS? PERIPHERAL NEUROSYPHILIS CENTRAL NEUROSYPHILIS MENINGEAL VASCULAR PARENCHYMATOUS MENINGOVASCULAR VASCULOPARENCHYMATOUS DIFFUSE ( = MENINGOVASCULOPARENCHYMATOUS) GUMMA CHART 1 =CLINICAL FORMS OF NEUROSYPHILIS= =HEAD AND FEARNSIDES, 1914= SYPHILIS MENINGOVASCULARIS CEREBRAL FORMS HEMIPLEGIA AFFECTION OF THE CRANIAL NERVES MUSCULAR ATROPHY LATERAL AND COMBINED DEGENERATIONS EPILEPSY SYPHILIS CENTRALIS DEMENTIA PARALYTICA TABES DORSALIS MUSCULAR ATROPHY OPTIC ATROPHY GASTRIC CRISES EPILEPTIC MANIFESTATIONS CHART 2