Article révisé par les pairs
Résumé : Friedrich Nietzsche (1844-1900) is a German philosopher who had considerable influence in the 20th century. He died early in a state of dementia with strokes for a long time attributed to general paralysis. In the last twenty years, this diagnosis of tertiary syphilis has been widely questioned in many publications. Born with a pupil of Adie and a high myopia, he had very soon in early childhood severe migraine attacks and developed a bipolar disorder type I whose first manifestations occurred before the age of 30 years. The maniac phases will help him to produce an important work, interspersed with depressive episodes with suicidal ideas. Psychotic attacks will lead to his confinement at the age of 45 and he will develop dementia associated with stroke, reminiscent of subcortical ischemic vascular dementia of Binswanger. He died at age 55 from pneumonia after a new stroke. Taking into account the family history, two diagnoses can be considered. If one considers the paternal side, one could have a hereditary form of Binswanger vascular dementia, CADASIL (autosomal dominant cerebral arterial disease with subcortical infarction and leukoencephalopathy). If we consider the maternal side, we can propose a mitochondrial disease, MELAS syndrome. The goal of our work is to review this literature in a systematic way and to present and then discuss the proposed new diagnoses. We also comment on the influence of Nietzsche’s medical troubles on his philosophical works.