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Copper Deficiency Myelopathy — SCE Neurology MCQ

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HardPeripheral Neuropathy & NeuromuscularCopper Deficiency MyelopathySCE Neurology

A 55-year-old man presents with progressive difficulty walking over 2 years. He has a spastic paraparesis with dorsal column sensory loss (impaired proprioception and vibration) in both legs. He also has bilateral optic atrophy. He drinks 60 units of alcohol per week and smokes 20 cigarettes per day. Serum B12 and folate are normal. Copper is low. What is the most likely diagnosis?

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Correct answer: C — Copper deficiency myelopathy with associated optic neuropathy

Copper deficiency can cause a subacute-combined-degeneration-like myelopathy with dorsal-column and corticospinal features, peripheral neuropathy and optic neuropathy. In this presentation the low copper concentration provides a unifying and treatable cause.

Reference: Kumar, Copper deficiency myelopathy: https://pubmed.ncbi.nlm.nih.gov/20232210/