Tangier disease (TD) is a rare autosomal codominant disease caused by mutations in the ATP-binding cassette transporter A1 gene ( ABCA1 ) on chromosome 9q31.1 As a consequence of impaired ABCA1 function, cholesterol accumulates in macrophages and other cells of the reticulo-endothelial system,2 leading to hepatosplenomegaly, lymphadenopathy, and enlarged yellow tonsils. Almost complete absence of high-density lipoprotein cholesterol (HDL) and low or absent levels of apolipoprotein A-I (apoA-I) are characteristic. Neurologically, patients with TD often have a peripheral neuropathy. Relapsing and remitting asymmetric mono- or polyneuropathy and slowly progressive distal symmetric polyneuropathy are more frequent than a severe syringomyelia-like subtype.3 Mutations in the ABCA1 gene have been described in more than 10 different pedigrees. However, there is no known genotype–phenotype correlation. Here we studied the ABCA1 gene sequence together with a detailed sural nerve biopsy in a family from Afghanistan with a case of progressive syringomyelia-like phenotype and severe premature atherosclerosis. ### Methods. Methods are described in appendix e-1 on the Neurology ® Web site at www.neurology.org. #### Case report. A 49-year-old Afghan Caucasian patient presented with a 15-year history of progressive syringomyelia-like syndrome with episodes of appendicular stabbing pain. Apart from tonsillectomy at age 14 his medical history was unremarkable. Examination revealed marked …
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