Strachan Syndrome

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Strachan Syndrome (pronounced "Strawn") is a nutritional disorder that presents as a triad of optic, auditory and painful symmetrical sensory polyneuropathy. Clinical features include numbness and cramps in the limbs, reduced vision, and sensorineural deafness. Some patients have a rash of the face and genitals. As this neuropathy is painful, the Musculoskeletal Physician should be aware of it. See also Nutritional Peripheral Neuropathies.

Risk Factors

Vegans are susceptible to B12 and riboflavin (B2) deficiencies, with the latter being less well known. These two vitamins are found predominantly in meat and dairy produce. In New Zealand true veganism is rare at 0.74% of the population. Nutritional deficiencies can occur in a wide array of other conditions such as anorexia nervosa, severe ARFID (e.g. in autism), malabsorption syndromes, and certain genetic conditions.

Bariatric surgery and alcoholism are further risk factors for B1, B6, and B12 deficiencies.

Specific Deficiencies

Thiamine (B1): Vitamin B1 deficiency commonly presents as Wernicke's encephalopathy. However patients can also have a clinical presentation similar to Guillain-Barre syndrome, with predominantly motor effects.

Riboflavin (B2): Vitamin B2 (riboflavin) is an essential, water-soluble component of coenzymes such as FAD and FMN. Deficiency in riboflavin is called ariboflavinosis.

Symptoms include sore throat, hyperemia of pharyngeal mucous membranes, edema of mucous membranes, cheilitis, stomatitis, and glossitis. Animal studies have shown that deficiency can cause peripheral neuropathy.

There is no good way of testing for riboflavin (B2) nutritional status. You can test plasma levels but this reflects recent dietary intake - In Auckland the test must be vetted by a pathologist. One indirect measure that doesn't need pathologist approval is plasma acetylecarnitine and urine organic acids (fasted - the patient needs to be in a fat dependent catabolic state). These are tests used to detect fatty acid oxidation disorders, so its not the typical test for riboflavin deficiency, but these enzymes require FAD as a cofactor.

Vitamin B12: Well known, not repeated here.

Resources

Strachan and riboflavin - Kramarz 2024.pdf - 1.81 MB (f)