— This case report is a useful addition to the gorwing number of reports about SM subsequent to the article by Krauthammer and myself. We had not expected that our review would be truly comprehensive, nor had we hoped to stimulate clinical observation and additional reports. In that light, the report by Mapelli and Bellelli is of clinical and research significance. Clinically, it should alert clinicians and practitioners as to the continued incidence of NS, although at a much lower level than in previous decades before the availability of penicillin. Second, understanding the theoretical level of the neuropathologic and pathophysiologic factors of NS should help to clarify possible brain mechanisms that lead to the productions of the manic syndrome.