Acute and bilateral blindness due to optic neuropathy associated with copper deficiency.
BACKGROUND
Acquired copper deficiency in adults is associated with a subacute to chronic progressive myeloneuropathy and optic neuropathy.


OBJECTIVE
To describe an individual after gastric bypass surgery who developed a chronic progressive myeloneuropathy, an acute optic neuropathy, along with anemia and leukopenia.


METHODS
Case report.


METHODS
Academic center. Patient A 55-year-old woman, following gastric bypass surgery 22 years earlier, developed progressive numbness, weakness, and sphincter disturbance over 6 years. She awoke one morning with bilateral blindness. Examination findings showed evidence of severe myelopathy and peripheral neuropathy.


METHODS
Magnetic resonance imaging, optical coherence tomography, electrophysiologic studies, nerve and muscle biopsy specimens, and vision testing.


RESULTS
Over 1 year of follow-up, copper infusion therapy seemed to stabilize the progressive myeloneuropathy and improved leukopenia and anemia. It had no effect on the optic neuropathy. Optic nerve tissue injury was observed on magnetic resonance diffusion tensor imaging and on optical coherence tomography.


CONCLUSIONS
Copper deficiency should be considered in cases of atypical optic neuropathy. Serum copper levels should be monitored in patients with a compatible neurologic syndrome who have undergone gastric bypass surgery. Although visual acuity did not improve after copper infusion in our patient, prompt recognition of copper deficiency may prevent further deterioration.
Naismith
Robert T
RT
Department of Neurology, Washington University, Campus Box 8111, 660 S Euclid Ave, St Louis, MO 63110, USA. naismithr@neuro.wustl.edu
Shepherd
James B
JB
Weihl
Conrad C
CC
Tutlam
Nhial T
NT
Cross
Anne H
AH
D000740:Anemia / Q000209:etiology; D001766:Blindness / Q000209:etiology*; D003300:Copper / Q000008:administration & dosage / Q000172:deficiency*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D007972:Leukoplakia, Oral / Q000209:etiology; D008875:Middle Aged; D009460:Neurologic Examination; D009900:Optic Nerve / Q000473:pathology; D009901:Optic Nerve Diseases / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology; D013118:Spinal Cord Diseases / Q000209:etiology; D041623:Tomography, Optical Coherence
D003300:Copper