Copper deficiency-associated myelopathy in cryptogenic hyperzincemia: a case report

Main Article Content

Carlotta Mutti
Veronica Bazzurri
Elena Tsantes
Erica Curti
Liborio Parrino
Franco Granella


posterior myelopathy, copper, zinc, spine MRI


Copper deficiency syndrome is an underestimated cause of posterior myelitis. We describe the case of a 41-year-old woman, who developed a subacute ataxic paraparesis associated with low back pain. Her 3T spine MRI showed a thin hyperintense FS-Echo T2 longitudinally extensive lesion involving the posterior columns of the cervical cord (from C2 to C6). An extensive diagnostic work-up excluded other causes of myelopathy and blood tests pointed out hypocupremia and mild hyperzincemia. Patients affected by this rare form of oligoelement deficiency typically develop progressive posterior column dysfunction with sensory ataxia and spasticity, sometimes associated with sensori-motor polyneuropathy. Clinical and radiological characteristics of posterior myelopathy due to copper deficiency are briefly reviewed. Physicians should be aware of this condition since a prompt introduction of copper supplementation can avoid progression of the neurological damage.


Download data is not yet available.
Abstract 349 | PDF Downloads 211


1. Verma R, Praharaj HN, Khanna VK, Garg RK, Singh MK, Malhotra HS. Study of micronutrients (copper, zinc and vitamin B12) in posterolateral myelopathies. J Neurol Sci. 2013;329(1-2):11–16. doi:10.1016/j.jns.2013.03.004
2. Khimani F, Livengood R, Esan O, et al. Pancytopenia related to dental adhesive in a young patient. Am J Stem Cells. 2013;2(2):132–136. Published 2013 Jun 30.
3. Ferrara JM, Skeen MB, Edwards NJ, Gray L, Massey EW. Subacute combined degeneration due to copper deficiency. J Neuroimaging. 2007;17(4):375–377. doi:10.1111/j.1552-6569.2007.00126.x
4. Martinelli D, Travaglini L, Drouin CA, et al. MEDNIK syndrome: a novel defect of copper metabolism treatable by zinc acetate therapy [published correction appears in Brain. 2013 Oct;136(Pt 10):e256]. Brain. 2013;136(Pt 3):872–881. doi:10.1093/brain/awt012
5. Kumar N. Pearls: myelopathy. Semin Neurol. 2010;30(1):38–43. doi:10.1055/s-0029-1244993
6. Prodan CI, Bottomley SS, Vincent AS, Cowan LD, Holland NR, Lind SE. Hypocupremia associated with prior vitamin B12 deficiency. Am J Hematol. 2007;82(4):288–290. doi:10.1002/ajh.20766
7. Allred JW, Aulino JM. Hypocupremia-associated myelopathy. J Comput Assist Tomogr. 2007;31(1):157–159. doi:10.1097/01.rct.0000233124.75560.c6
8. Winston GP, Jaiser SR. Copper deficiency myelopathy and subacute combined degeneration of the cord - why is the phenotype so similar?. Med Hypotheses. 2008;71(2):229–236. doi:10.1016/j.mehy.2008.03.027
9. Mittal SO, Machado DG. Hypocupremia: a possible association with late cortical cerebellar atrophy. Tremor Other Hyperkinet Mov (N Y). 2014;4:202. Published 2014 Sep 9. doi:10.7916/D8G44NHV

Most read articles by the same author(s)