Copper deficiency myeloneuropathy is rare but increasingly recognized as a cause of neurological impairment, presenting similarly to subacute combined degeneration of the cord secondary to vitamin B12 deficiency.
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Clinical presentation
Patients typically present with a proprioceptive loss, due to dorsal column involvement, which manifests as a sensory ataxia 1.
Copper deficiency is not common and may be present in a few clinical circumstances:
malabsorption syndromes
zinc toxicity: there is a competitive gastrointestinal absorption between copper and zinc
Pathology
The serum copper and ceruloplasmin levels are low.
Radiographic features
MRI is the modality of choice for assessing suspected cases.
MRI
Spinal cord imaging may be normal in up to half of all cases, but when abnormal, classically demonstrates symmetric high T2 signal in the dorsal columns 1,2.
Treatment and prognosis
Copper supplementation can arrest further neurological deterioration and even reverse symptoms and imaging findings 1.
Differential diagnosis
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subacute combined degeneration of the cord
identical imaging features