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J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2012-302784
  • Neurological picture

Acquired hepatocerebral degeneration revealed by neurogenic hyperventilation syndrome and myelitis

  1. Pierre Labauge5
  1. 1University Lille Nord de France, UDSL, Lille, France
  2. 2Department of Neurology and Movement Disorders Clinic, Lille University Hospital, Lille, France
  3. 3EA 1046, Memory Clinic, Lille University Hospital, Lille, France
  4. 4UMR837 Team 6 INSERM, University Lille, France
  5. 5Department of Neurology, Montpellier University Medical Center, Gui de Chauliac Hospital, Montpellier, France
  1. Correspondence to Dr Nicolas Carriere, Service de Neurologie et Pathologies du Mouvement, HÃ'pital Roger Salengro, CHRU Lille, Rue Emile Laine, F-59037 Lille Cedex, France; nicolas.carriere{at}chru-lille.fr

  1. Contributors NC prepared the manuscript with the assistance of the other authors. CS and AR were the patient's attending physicians. They performed examinations and made patient care decisions. PL provided scientific advice on the diagnosis and on drafting the manuscript.

  • Received 3 April 2012
  • Revised 28 May 2012
  • Accepted 13 June 2012
  • Published Online First 8 July 2012

A 46-year-old woman with a history of kidney transplant for IgA nephropathy (on tacrolimus and mycophenolate mofetil), type II diabetes and non-alcoholic steatohepatitis was admitted for gait instability. Neurological examination revealed lower limb sensory ataxia and brisk patellar reflexes. Brain/spinal MRI results were normal. Blood tests disclosed macrocytosis (but no vitamin deficiencies) and mild hepatic cytolysis. Lumbar puncture showed the absence of cells, normal protein, hypoglycorrhachia (glycorrhachia: 0.62 g/l; glycaemia: 1.65 g/l) and no oligoclonal bands. Cerebrospinal fluid cultures were negative. Assays for neurotropic viruses, paraneoplastic …

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