The authors report the clinical and molecular findings in eight patients wi
th hyperornithinemia, hyperammonemia, and homocitrullin-uria (HHH) syndrome
. The most consistent neurologic finding was spastic paraparesis, seen in f
ive of the eight patients. However, all showed signs of pyramidal tract inv
olvement. A broad spectrum of pathogenetic mutations (including missense, n
onsense, splice site, insertion, and deletions) were identified in the ORNT
1 gene.