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Clinical Problem Solving: Two Patients With Gait Instability and Difficulty With Hand Coordination.

Trevor Glenn1, Amine Awad1, Galina Gheihman2

  • 1Mass General Brigham Neurology, Brigham & Women's Hospital and Massachusetts General Hospital, Boston, MA, USA.

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|January 13, 2025
PubMed
Summary

Subacute gait instability and hand discoordination can signal sensory ataxia. Two cases reveal this is often caused by copper deficiency myelopathy from excess zinc, treatable with specific regimens.

Keywords:
case reportgait imbalancesensory ataxia

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Area of Science:

  • Neurology
  • Neuroscience
  • Biochemistry

Background:

  • Gait instability and hand discoordination are common neurological symptoms.
  • A broad differential diagnosis exists for subacute to chronic gait disturbances.
  • Neurological examination is crucial for localizing deficits and suggesting etiologies.

Purpose of the Study:

  • To highlight an approach to diagnosing gait dysfunction with hand discoordination.
  • To present cases of sensory ataxia secondary to copper deficiency myelopathy.
  • To discuss treatment strategies for this condition.

Main Methods:

  • Case report of two patients with progressive gait and hand dysfunction.
  • Detailed neurological examination findings.
  • Diagnostic workup including biochemical tests to identify copper and zinc levels.

Main Results:

  • Both patients presented with worsening gait instability and bilateral hand discoordination.
  • Sensory ataxia was identified as the underlying cause of the symptoms.
  • Diagnosis confirmed as copper deficiency myelopathy secondary to excessive zinc intake.

Conclusions:

  • Copper deficiency myelopathy due to zinc excess can manifest as sensory ataxia.
  • Early diagnosis and appropriate treatment are essential for managing this condition.
  • Neurological assessment plays a key role in identifying treatable causes of gait and coordination disorders.