We describe nine patients with fat malabsorption in whom a spectrum of vitamin E 
deficiency was present. Early deficiency was generally asymptomatic, and 
intermediate deficiency produced some impairment. Ataxia, weakness, reflex 
changes, impaired vision, and pigment retinopathy were associated with chronic, 
advanced deficiency. In the last group, delayed central somatosensory conduction 
and amplitude reduction of the electroretinogram were present. In adults, a 
severe vitamin E deficiency state existed for more than 5 years before producing 
measurable neurologic damage. The clinical picture is less homogeneous than 
previously suggested, and electrophysiologic abnormalities need not predate 
clinical dysfunction.