Combined Optic Neuropathy and Myelopathy Secondary to Copper Deficiency

Pineles, Stacy L.; Wilson, Christina A.; Balcer, Laura J.; Slater, Robert; Galetta, Steven L.

doi:10.1016/j.survophthal.2010.02.002

« Previous Next »Survey of Ophthalmology
Volume 55, Issue 4 , Pages 386-392, July 2010

Combined Optic Neuropathy and Myelopathy Secondary to Copper Deficiency

Stacy L. Pineles, MD
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- Reprint address: Dr Steven L Galetta, 3400 Spruce Street, Philadelphia, PA 19104.
Christina A. Wilson, MD, PhD
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
Laura J. Balcer, MD, MSCE
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
Robert Slater, MD
- Department of Neurology, Delaware County Memorial Hospital, Drexel Hill, Pennsylvania, USA
Steven L. Galetta, MD
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

published online 10 May 2010.

Andrew Harrison and Michael Lee, Editors

Abstract

We report two patients, both with a history of gastric surgery, who presented with progressive optic neuropathy and myelopathy. The patients' symptoms were initially attributed to vitamin B12 deficiency and/or neuromyelitis optica; however, after the neurologic deficits continued to progress with the use of conventional treatments, further evaluation was initiated, and a severe copper deficiency was revealed. Copper deficiency is a rare cause of progressive optic neuropathy and myelopathy and should be considered in the differential diagnosis. It is crucial to elicit a history of gastric surgery or other risk factors for hypocupremia in those patients undergoing an evaluation for subacute or chronically progressive optic neuropathy or myelopathy.

Key words: copper deficiency, gastric bypass, myelopathy, optic neuropathy, vitamin B12 deficiency