SHM Converge Scientific Abstract ePoster Gallery-"I Can't Feel My Feet When Without Cu"

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This case describes a 96-year-old otherwise healthy Japanese man who developed progressive ascending numbness, paresthesia, proprioceptive loss, gait instability, fatigue, appetite loss, weight loss, and anemia over 1–2 months. He initially underwent CT imaging that showed multilevel spinal stenosis, but his neurologic symptoms worsened, prompting reevaluation.<br /><br />MRI of the cervical and thoracic spine revealed T2 hyperintensity in the dorsal columns from C2 to C6 and in the thoracic spine, raising concern for subacute combined degeneration versus copper or vitamin E deficiency. Extensive laboratory workup was unrevealing for other causes, including thyroid disease, diabetes, inflammatory, demyelinating, paraneoplastic, and multiple vitamin deficiencies. Zinc was mildly elevated, while serum copper was undetectable.<br /><br />He was diagnosed with copper deficiency myelopathy, a rare but important and often reversible cause of neurologic dysfunction. Copper is an essential trace element involved in energy production, hematopoiesis, iron metabolism, neurotransmission, and connective tissue formation. Deficiency can result from impaired absorption in the duodenum, such as after bariatric surgery, proximal bowel resection, or celiac disease, and can also be caused by excess zinc intake. Zinc induces metallothionein, which binds copper more strongly than zinc, trapping copper in enterocytes and depleting body stores.<br /><br />The patient was treated urgently with intravenous copper infusions followed by oral copper supplementation. His copper level normalized and he experienced improvement in fatigue, appetite, and the sensory level of his neuropathy, though paresthesias persisted.<br /><br />The case highlights that copper deficiency should be considered in older adults with lower-extremity paresthesias, sensory ataxia, myelopathy, or unexplained anemia, especially when MRI shows dorsal column abnormalities. Early recognition is crucial because delayed diagnosis can lead to severe neurologic injury, but timely treatment can reverse much of the syndrome.

Asset Subtitle

Kavitha Subramanian

Meta Tag

Author List Alice Cha, Kavitha Subramanian

Category Clinical Vignettes

Concept Copper Deficiency

Concept Copper Deficiency Myelopathy

Concept Copper Replacement Therapy

Concept Myelopathy

Concept Neurologic Deficit

Distinguished Non-Finalist

Presenter Organization Stanford University

Presenting Author Kavitha Subramanian

Track Adult

Keywords

copper deficiency myelopathy

dorsal column hyperintensity

sensory ataxia

paresthesia

proprioceptive loss

anemia

zinc elevation

intravenous copper

oral copper supplementation

neurologic dysfunction

Copper Deficiency

Copper Deficiency Myelopathy

Copper Replacement Therapy

Myelopathy

Neurologic Deficit