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Surv Ophthalmol. 2010 Jul-Aug;55(4):386-92. doi: 10.1016/j.survophthal.2010.02.002. Epub 2010 May 10.

Combined optic neuropathy and myelopathy secondary to copper deficiency.

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Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.


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.

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