Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Peripheral neuropathy, myelopathy, cerebellar ataxia, and subclinical optic neuropathy associated with copper deficiency occurring 23 years after total gastrectomy

Meiko Inaba, M.D., Takako Torii, M.D., Koji Shinoda, M.D., Ryo Yamasaki, M.D., Ph.D., Yasumasa Ohyagi, M.D., Ph.D. and Jun-ichi Kira, M.D., Ph.D.

Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyusyu University

We report a 61-year-old man with slowly progressive gait disturbance and paresthesia in the lower extremities following a total gastrectomy for gastric cancer 23 years previously. The patient presented with hyperreflexia, peripheral sensory neuropathy, and cerebellar ataxia. Magnetic resonance imaging showed atrophy of the cerebellum, and electrophysiological findings suggested the presence of disorder in both sides of the pyramidal tract, dorsal column, peripheral nerves, and optic nerve. Laboratory findings revealed anemia, neutropenia, and a remarkably low serum copper level (10 μg/dl; normal: 68-128). His serum vitamin E was slightly low and his serum vitamin B12 was within the normal limits. After administering an oral copper supplement, his symptoms improved with normalization of the serum copper level. We need to pay attention to myeloneuropathy caused by copper deficiency if the patient has a past history of total gastrectomy.
Full Text of this Article in Japanese PDF (392K)

(CLINICA NEUROL, 51: 412|416, 2011)
key words: copper deficiency, vitamin E deficiency, peripheral neuropathy, myelopathy, post-gastrectomy

(Received: 21-Nov-10)