Copper deficiency myeloneuropathy

Last revised by Rohit Sharma on 11 Feb 2024

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

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 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.

Copper supplementation can arrest further neurological deterioration and even reverse symptoms and imaging findings 1

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