Copper deficiency myelopathy (CDM)

What is copper deficiency myelopathy (CDM)? 

Copper deficiency myelopathy is a rare treatable form of noncompressive myelopathy due to copper deficiency.

Copper is active in several enzymes important for structure and function in the nervous system.

Copper deficiency myelopathy is over three times more common in women than men, and zinc overload, upper GI surgery, and celiac disease are important risk factors.

In enterocytes, zinc upregulates a chelator metallothionein that preferentially binds copper and causes it to be excreted. A careful history must include denture use as many denture adhesives contain zinc.

These denture adhesives can be an important source of nondietary zinc. Malabsorption of copper can be caused by either previous upper GI surgery such as gastric bypass, or celiac disease.

Routine blood work may reveal anemia due to copper deficiency’s effect on the bone marrow.

Clinically it is indistinguishable from subacute combined degeneration secondary to vitamin B12 deficiency, and the spinal magnetic resonance imaging (MRI) may show increased T2 signal in the posterior cord.

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