Human Swayback Due to Copper Deficiency

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.