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Sixty consecutive patients with progressive intellectual deterioration were evaluated by a specific protocol. Eighteen (30%) were found to have an underlying disease potentially reversible by medical or surgical therapy. Sixteen patients had a specific diagnosable but untreatable disease as a cause of dementia. The laboratory and radiologic tests of the protocol that uncovered treatable illnesses were the radioisotope brain scan (two cases of bilateral subdural hematoma), the pneumoencephalogram (seven patients with normal-pressure hydrocephalus), thyroid function screen, and liver function studies (one case each). Unrewarding tests included serum barbiturate, bromide, vitamin B12, and folate levels.

SUMMARY A 27-year-old male developed cerebral and cerebellar atrophy over a period of five years of extensive glue sniffing. He also developed bilateral optic atrophy with blindness and severe sensorineural hearing loss. Investigation failed to show any other cause for the visual or hearing loss. Peripheral polyneuropathy and central nervous system damage may follow chronic toluene toxicity, but these auditory and visual complications have not previously been described.The acute central nervous system symptoms after inhalation of doses of toluene, the major component of glue vapour, include headache, nausea, tinnitus, ataxia, and less commonly, confusion, erratic behaviour, visual hallucination and seizures. [1][2][3] Sudden death has occurred when physical exercise followed glue sniffing; the mechanism probably involves cardiac arrhythmia. Chronic toxicity has been associated with peripheral neuropathy,45 permanent encephalopathy,6 cerebellar dysfunction, '-8 and

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