title: Study of micronutrients (copper, zinc and vitamin B12) in posterolateral myelopathies.
abstract: BACKGROUND
  Vitamin B12 deficiency is a well recognized cause of posterolateral myelopathy. In Indian subcontinent, it may coexist with nutritional copper deficiency producing partial response of patients to B12 supplementation. Hence the study was planned to look for association of hypocupremia and B12 deficiency.
  
  
  METHODS
  Twenty-three patients with posterolateral myelopathy (Romberg sign positive) were enrolled and investigated for levels of vitamin B12, copper and zinc and followed up for six months.
  
  
  RESULTS
  In three patients, copper deficiency alone was found to be the cause. In another three, both copper and vitamin B12 were deficient. In all these six patients, ceruloplasmin and 24h urinary copper were found to be low suggesting dietary copper deficiency. Hyperzincemia was found in four of these patients. Magnetic resonance imaging of spine was normal in lone Cu deficient patients but showed T2 hyperintensity of posterior column in lone B12 or combined B12 and copper deficiency.
  
  
  CONCLUSIONS
  In cases of B12 deficiency myelopathy not responding to supplementation, copper deficiency must be sought at the earliest to avoid and treat persistent neurological disability.
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, U.P., India. drrajeshverma32@yahoo.com
authors.forename: Rajesh
authors.initials: R
authors.lastname: Verma
authors.forename: H N
authors.initials: HN
authors.lastname: Praharaj
authors.forename: Vinay Kumar
authors.initials: VK
authors.lastname: Khanna
authors.forename: Ravindra Kumar
authors.initials: RK
authors.lastname: Garg
authors.forename: Maneesh Kumar
authors.initials: MK
authors.lastname: Singh
authors.forename: Hardeep Singh
authors.initials: HS
authors.lastname: Malhotra
mesh_terms: D000200:Action Potentials / Q000502:physiology; D000328:Adult; D000704:Analysis of Variance; D001259:Ataxia / Q000097:blood / Q000150:complications*; D001921:Brain / Q000473:pathology; D003300:Copper / Q000097:blood*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000473:pathology; D013118:Spinal Cord Diseases / Q000097:blood* / Q000150:complications*; D018709:Statistics, Nonparametric; D014805:Vitamin B 12 / Q000097:blood*; D014806:Vitamin B 12 Deficiency / Q000150:complications; D015032:Zinc / Q000097:blood*
chemical_list: D003300:Copper; D015032:Zinc; D014805:Vitamin B 12