title: Hypocupremia: a possible association with late cortical cerebellar atrophy.
abstract: BACKGROUND
  We report a patient, diagnosed with late cortical cerebellar atrophy, who had persistent low serum copper levels.
  
  
  METHODS
  A 48-year-old male developed progressive difficulty with balance, frequent falls, and dysarthric speech, which worsened over a short time span. He had an extensive ataxia work-up, which was unremarkable except for persistent low serum copper levels despite adequate supplementation. Magnetic resonance imaging of the brain showed marked cerebellar atrophy. The patient experienced progressive worsening of symptoms, which did not improve with either oral or parenteral copper supplementation.
  
  
  CONCLUSIONS
  To our knowledge, ours is the first case report of late cortical cerebellar atrophy in the setting of low serum copper levels. The current report should trigger further research in mechanisms leading to copper deficiency and its possible role in cerebellar disease.
authors.affiliation: Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Shivam Om
authors.initials: SO
authors.lastname: Mittal
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Duarte G
authors.initials: DG
authors.lastname: Machado
keywords: Hypocupremia; cerebellar ataxia; cerebellar atrophy; cerebellum; ceruloplasmin; late cortical cerebellar atrophy