Copper deficiency-associated myelopathy in cryptogenic hyperzincemia: a case report
Keywords:
posterior myelopathy, copper, zinc, spine MRIAbstract
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.
References
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
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.
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
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
Kumar N. Pearls: myelopathy. Semin Neurol. 2010;30(1):38–43. doi:10.1055/s-0029-1244993
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
Allred JW, Aulino JM. Hypocupremia-associated myelopathy. J Comput Assist Tomogr. 2007;31(1):157–159. doi:10.1097/01.rct.0000233124.75560.c6
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
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
Downloads
Published
Issue
Section
License
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.