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Myelopathy due to copper deficiency

Last edited: 4/15/2026

Overview

Copper deficiency myelopathy is a neurological disorder characterized by progressive weakness and sensory disturbances in the limbs, often associated with inadequate copper intake or absorption. This condition can be exacerbated by bariatric surgeries like gastric bypass, leading to deficiencies in fat-soluble vitamins such as vitamin A 1.

Diagnosis

  • Clinical Presentation: Progressive gait disturbances, lower extremity weakness, and sensory deficits 1.
  • Laboratory Tests: Low serum copper levels, elevated serum ceruloplasmin levels (though less reliable), decreased serum holotranscobalamin II (holoTC) and elevated total homocysteine levels 1.
  • Neurophysiological Studies: Electromyography (EMG) and nerve conduction studies may show signs of demyelination or axonal damage 1.
  • Differentiation: Differentiate from other myelopathies caused by B12 or folate deficiencies through comprehensive vitamin panel and response to specific supplementation 1.

    • Management

  • First-Line Treatment: Parenteral copper supplementation, typically starting with doses adjusted to correct deficiency (specific dosing not detailed in abstracts) 1.
  • Adjunctive Therapy: Vitamin A supplementation to address concurrent deficiencies 1.
  • Monitoring: Regular follow-up to assess clinical improvement and adjust supplementation as needed 1.

    • Special Populations

  • Post-Gastric Bypass Patients: Higher risk due to malabsorption issues; vigilant monitoring and early supplementation crucial 1.
  • Vitamin Deficiencies: Combined deficiencies (e.g., vitamin A and copper) require comprehensive nutritional support tailored to identified deficiencies 1.

    • Key Recommendations

  • Evaluate patients with myelopathy symptoms post-gastric bypass for copper and vitamin A deficiencies (Evidence: Moderate 1).
  • Initiate parenteral copper supplementation for confirmed copper deficiency myelopathy (Evidence: Weak 1).
  • Consider concurrent vitamin A supplementation in cases of combined deficiencies to enhance recovery (Evidence: Expert opinion 1).

    • References

    1 AlHassany AA. Night blindness due to vitamin A deficiency associated with copper deficiency myelopathy secondary to bowel bypass surgery. BMJ case reports 2014. link

    Original source

    1. [1]
      Night blindness due to vitamin A deficiency associated with copper deficiency myelopathy secondary to bowel bypass surgery. — AlHassany AA BMJ case reports (2014)
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