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Genetic and Rare Diseases Information Center (GARD)

Hereditary endotheliopathy, retinopathy, nephropathy, and stroke

Other Names for this Disease
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What are the signs and symptoms of Hereditary endotheliopathy, retinopathy, nephropathy, and stroke?

Very few cases of hereditary endotheliopathy with retinopathy, nephropathy, and stroke (HERNS) have been reported. Based upon these reports, it appears that symptoms often begin in the 30’s or 40’s. Early symptoms, which may differ among individuals, may include depression, anxiety, paranoia, decreased central vision, and/or blind spots. Within the next 4 to 10 years affected individuals reportedly experience focal neurologic deficits that may have a sudden stroke-like onset. The stroke-like episodes may last several days. Headache and seizures may also occur. As the condition progresses, symptoms may include speech impairment, partial paralysis, and/or apraxia. Other symptoms of advanced disease include loss of vision as well as physical and mental skills. Kidney failure, hematuria (blood in the urine) and proteinuria has been described in some affected individuals.[1][2][3][4]

Common to all affected individuals is the presence of cerebral microvasculopathic lesions. Some individuals go on to develop mass lesions, predominantly involving the right frontal lobe. These lesions are often mistaken for tumors.[4]
Last updated: 10/9/2013

The Human Phenotype Ontology provides the following list of signs and symptoms for Hereditary endotheliopathy, retinopathy, nephropathy, and stroke. If the information is available, the table below includes how often the symptom is seen in people with this condition. You can use the MedlinePlus Medical Dictionary to look up the definitions for these medical terms.

Signs and Symptoms Approximate number of patients (when available)
Abnormality of the retinal vasculature 90%
Visual impairment 90%
Abnormality of movement 50%
Behavioral abnormality 50%
Cerebral ischemia 50%
Developmental regression 50%
Hematuria 50%
Hemiplegia/hemiparesis 50%
Migraine 50%
Nephropathy 50%
Neurological speech impairment 50%
Proteinuria 50%
Retinopathy 50%
Seizures 50%
Cataract 7.5%
Glaucoma 7.5%
Incoordination 7.5%
Micronodular cirrhosis 5%
Abnormality of the musculature of the lower limbs -
Abnormality of the periventricular white matter -
Adult onset -
Apraxia -
Autosomal dominant inheritance -
Central nervous system degeneration -
Dementia -
Dysarthria -
Elevated erythrocyte sedimentation rate -
Elevated hepatic transaminases -
Hemiparesis -
Limb pain -
Lower limb hyperreflexia -
Macular edema -
Pigmentary retinal degeneration -
Progressive -
Progressive forgetfulness -
Progressive visual loss -
Punctate vasculitis skin lesions -
Retinal exudate -
Retinal hemorrhage -
Stroke -
Telangiectasia -
Vasculitis in the skin -

Last updated: 7/1/2016

The Human Phenotype Ontology (HPO) has collected information on how often a sign or symptom occurs in a condition. Much of this information comes from Orphanet, a European rare disease database. The frequency of a sign or symptom is usually listed as a rough estimate of the percentage of patients who have that feature.

The frequency may also be listed as a fraction. The first number of the fraction is how many people had the symptom, and the second number is the total number of people who were examined in one study. For example, a frequency of 25/25 means that in a study of 25 people all patients were found to have that symptom. Because these frequencies are based on a specific study, the fractions may be different if another group of patients are examined.

Sometimes, no information on frequency is available. In these cases, the sign or symptom may be rare or common.

  1. Dichgans M, Meschia JF. Cerebrovascular disorders. In: Rimoin DL et al. Principle and Practice of Medical Genetics, 5th ed. Philadelphia, PA: Churchill Livingston Elsevier; 2002;
  2. Jen JC, Baloh RW. Herediatry endotheliopathy with retinopathy, nephropathy, and stroke (HERNS). In: Bogousslavsky J, Caplan L., eds. Uncommon Causes of Stroke. 2nd ed. Cambridge University Press; 2001;
  3. Seifried C, Sitzer M, Jen J, Auburer G. HERNS. A rare, hereditary, multisystem disease with cerebral microangiopathy. Nervenartz. 2005;
  4. Cohn AC, Kotschet K, Veitch A, Delatycki MB, McCombe MF. Novel ophthalmological features in hereditary endotheliopathy with retinopathy, nephropathy and stroke syndrome. Clin Experiment Ophthalmol. April 2005; 33(2):181-183.

Other Names for this Disease
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.