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Acquired hypocupremia after gastric surgery.
Neeraj Kumar1, J Eric Ahlskog, John B Gross
1Department of Neuroogy, Mayo Clinic, Rochester, Minnesota 55905, USA. kumar.neeraj@mayo.edu
Summary
Copper deficiency can cause neurological problems years after gastric surgery. This condition, known as hypocupremic myelopathy, may also stem from absorptive defects, highlighting the need for awareness in clinical practice.
Area of Science:
- Neurology
- Gastroenterology
- Nutritional Science
Background:
- Copper is vital for nervous system function; deficiency can lead to myelopathy resembling vitamin B12 deficiency.
- Gastric surgery is an underrecognized risk factor for acquired copper deficiency.
- Menke's disease illustrates impaired copper absorption causing hypocupremia.
Observation:
- Two patients developed neurological deficits and copper deficiency years post-gastric surgery.
- Two additional patients without gastric surgery history presented with hypocupremic myelopathy.
- Literature review identified eight more cases of copper deficiency and neurological issues after gastric surgery.
Findings:
- Copper deficiency was confirmed as the cause of myelopathy in all studied patients.
- Gastric surgery preceded copper deficiency and neurological symptoms in some patients.
- Increased colonic copper content suggested an absorptive defect in patients without prior surgery.
Implications:
- Acquired copper deficiency is a potential delayed complication of gastric surgery.
- Copper deficiency myelopathy can mimic vitamin B12 deficiency.
- Primary absorptive defects should be considered when the cause of hypocupremia is unclear.