title: Combined optic neuropathy and myelopathy secondary to copper deficiency.
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.
authors.affiliation: Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Pineles
authors.forename: Christina A
authors.initials: CA
authors.lastname: Wilson
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Balcer
authors.forename: Robert
authors.initials: R
authors.lastname: Slater
authors.forename: Steven L
authors.initials: SL
authors.lastname: Galetta
mesh_terms: D000328:Adult; D000368:Aged; D003300:Copper / Q000097:blood / Q000172:deficiency*; D004596:Electroretinography; D005260:Female; D005743:Gastrectomy; D015390:Gastric Bypass; D006801:Humans; D008279:Magnetic Resonance Imaging; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000209:etiology*; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000209:etiology*; D041623:Tomography, Optical Coherence
chemical_list: D003300:Copper