Copper deficiency myeloneuropathy is rare but increasingly recognised as a cause of neurological impairment, presenting similarly to subacute combined degeneration of the cord secondary to B12 deficiency.
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
- gastric bypass surgery
- zinc toxicity: there is a competitive gastrointestinal absorption between copper and zinc
The serum copper and ceruloplasmin levels are low.
MRI is the modality of choice for assessing suspected cases.
Spinal cord imaging demonstrates symmetric high T2 signal in the dorsal columns 1.
In some patients, findings suggestive of demyelination have been reported 1.
Treatment and prognosis
Copper supplementation can arrest further neurological deterioration and even reverse symptoms and imaging findings 1.
subacute combined degeneration of the cord
- identical imaging features