Pellagra and the Nutritional Neuropathies: A Neuropathological Review

It is now well recognized that many of the syndromes previously described as pellagra, such as nutritional retrobulbar neuropathy, the ataxic, and burning feet syndromes, may occur as isolated manifestations of nutritional deficiency. The term “pellagra,” as it is often used, is no more than a generic title embracing a wide variety of nutritional disorders. The clinical status of the individual deficiency syndromes has been elucidated of late years in America (Spies et al., 1939; Harris, 1941), and with particular regard to the neurological disorders, in groups of prisoners of war in the Far East (Denny Brown, 1947) and Middle East (Spillane, 1947). The majority of the pathological studies of pellagra were completed in the era before advancing biochemical knowledge provided the impetus to further these clinical studies, and this is reflected in the great diversity of neuropathological changes described as “pellagrous.” The extensive literature contains many excellent studies of cases dying from malnutrition, and it now seems possible to attempt a correlation between the pathological findings and the more recently described individual syndromes. A review, therefore, of the neuropathological changes encountered in “pellagra” might be not untimely.