Nystagmus or ataxia is a rare manifestation of acquired hepatocerebral degeneration (AHCD). A 49-year-old woman presented with downbeat nystagmus and limb and gait ataxia. She was diagnosed as primary biliary cirrhosis with a gastric varix. Brain MRI showed cerebellar vermian atrophy and characteristic T1 high-signal intensities in bilateral globus pallidi and ventral midbrain. We report a rare case of AHCD manifesting prominent cerebellar symptoms. This has not yet been reported in Korea.