The symptoms are tingling and cramps in the arms and legs, followed by general muscular weakness.

In severe cases, atrophy of the skeletal muscles is observed, along with a loss of coordination and vision problems.

2,5-Hexanedione reacts with lysine residues in axonal proteins by Schiff base formation followed by cyclization to give pyrroles.

Oxidation of the pyrrole residues then causes cross-linking and denaturation of proteins, which perturbs axonal transport and function and causes damage to nerve cells.

[4] A common method involves hydrolysis of 2,5-dimethylfuran, a glucose derived heterocycle.