Central nervous system deficiency syndrome (garland syndrome; spillan-scott syndrome)    218

General: Cause unknown; found in prisoners who had long been on a deficie 919g65j nt diet; no improvement after normal diet resumed.

Ocular: Greatly reduced vision, particularly near vision, increasing over weeks or months but rarely progressing to complete blindness; relative or absolute central or paracentral scotomata; bitemporal pallor of the disks; optic neuropathy.

Clinical: Incomplete bilateral deafness, never proceeding to complete deafness; tinnitus; numbness and tingling in the legs, rarely in the hands; unsteadiness of gait; abnormal tendon reflexes (both hyperactive or absent); peripheral neuropathy.

Garland HG. A central nervous deficiency syndrome. Proc Roy Soc Med 1946; 39:178.

Geeraets WJ. Ocular Syndromes, 3rd ed. Philadelphia: Lea & Febiger, 1976.

Tucker K, Hedges TR. Food shortages and an epidemic of optic and peripheral neuropathy in Cuba. Nutr Rev 1993; 51:349-357.

Wilkinson PB, King A. Amblyopia due to vitamin deficiency. Lancet 1944; 1:528.