Human Swayback Due to Copper Deficiency

Sujatha Mogili, U. Lakshmanadoss, Gaurav Datta, J. O’Sullivan, Natan Khishchenko
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Abstract

A 74-year-old female presented with distal extremity burning paresthesias and gait imbalance of 3 months duration. Her past medical history includes gastrojejunostomy 5 years ago. No history suggestive of malnutrition or alcohol use. Physical examination revealed ataxic myelopathy. Her blood works revealed copper and ceruloplasmin levels, which are significantly reduced, consistent with copper deficiency. CSF analysis was normal. Nerve conduction studies demonstrated symmetric sensory motor axonal polyneuropathy. MRI of the cervical and thoracic spine revealed areas of abnormal, non-enhancing intramedullary T2 and FLAIR sequence hyper intense signal in the posterior cord. Patient was treated with intravenous copper and improved in few weeks. Copper deficiency may result from inadequate intake, malabsorption of any cause, including postgastrectomy, bacterial overgrowth or sprue. Manifestations include: neutropenia, thrombocytopenia and anemia and/or neurological symptoms of large fiber/posterior column and corticospinal tract dysfunction. Differential diagnosis of ataxic myelopathy should include copper deficiency in patients with predisposing conditions.
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人体因缺铜而摇摆
74岁女性,表现为远端灼烧性感觉异常和步态不平衡3个月。既往病史包括5年前的胃空肠造口术。没有营养不良或饮酒史。体格检查发现共济性脊髓病。她的血液检查显示铜和铜蓝蛋白水平明显降低,与缺铜一致。脑脊液分析正常。神经传导研究显示对称感觉运动轴突多发性神经病。颈椎和胸椎MRI显示髓内T2和FLAIR序列后脊髓异常,非强化信号区。患者接受静脉注射铜治疗,几周后病情好转。铜缺乏可能是由于摄入不足,吸收不良的任何原因,包括胃切除术后,细菌过度生长或口疮。表现包括:中性粒细胞减少、血小板减少、贫血和/或大纤维/后柱神经症状和皮质脊髓束功能障碍。共济失调性脊髓病的鉴别诊断应包括有易感条件的患者缺铜。
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