Journal of Neurology

, 254:1012 | Cite as

Myelo-optico-neuropathy in copper deficiency occurring after partial gastrectomy

Do small bowel bacterial overgrowth syndrome and occult zinc ingestion tip the balance?
  • Marco Spinazzi
  • Franca De Lazzari
  • Bruno Tavolato
  • Corrado Angelini
  • Renzo Manara
  • Mario Armani


Acquired copper deficiency has recently been recognized as a cause of myeloneuropathy mimicking subacute combined degeneration due to vitamin B-12 deficiency. A remote history of gastric surgery is frequently associated with this syndrome. However, the very limited prevalence of severe copper deficiency in patients with a history of gastric surgery suggests that additional contributing factors are likely to be involved. We describe a patient with copper deficiency and a previous Billroth II partial gastrectomy for gastric carcinoma, presenting with severe myelo-optico-neuropathy, demyelinating lesions of the brain, and subjective hyposmia. An abnormal glucose breath test also revealed small bowel bacterial overgrowth syndrome. Copper replacement therapy associated with antibiotic therapy was effective in preventing further neurological damage and in obtaining mild improvement. We propose that copper status should be evaluated in all patients presenting with unexplained noninflammatory myeloneuropathy. Small bowel bacterial overgrowth syndrome should be investigated as a cause of generalized malabsorption and a possible contributing factor to copper deficiency after gastric surgery, as should occult zinc ingestion.

Key words

copper deficiency spastic paraparesis optic neuropathy malabsorption neuropathy 


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Copyright information

© Steinkopff-Verlag 2007

Authors and Affiliations

  • Marco Spinazzi
    • 1
  • Franca De Lazzari
    • 2
  • Bruno Tavolato
    • 1
  • Corrado Angelini
    • 1
  • Renzo Manara
    • 3
  • Mario Armani
    • 1
  1. 1.Second Neurological Unit, Dept. of NeurosciencesUniversity of Padova Ospedale S. AntonioPadovaItaly
  2. 2.Gastroenterology UnitOspedale S. AntonioPadovaItaly
  3. 3.Neuroradiological UnitGeneral Hospital of PadovaPadovaItaly

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