Department of Neurology, King George Medical University, Lucknow, U.P., India.
J Neurol Sci. 2013 Jun 15;329(1-2):11-6. doi: 10.1016/j.jns.2013.03.004. Epub 2013 Apr 4.
Vitamin B12 deficiency is a well recognized cause of posterolateral myelopathy. In Indian subcontinent, it may coexist with nutritional copper deficiency producing partial response of patients to B12 supplementation. Hence the study was planned to look for association of hypocupremia and B12 deficiency.
Twenty-three patients with posterolateral myelopathy (Romberg sign positive) were enrolled and investigated for levels of vitamin B12, copper and zinc and followed up for six months.
In three patients, copper deficiency alone was found to be the cause. In another three, both copper and vitamin B12 were deficient. In all these six patients, ceruloplasmin and 24h urinary copper were found to be low suggesting dietary copper deficiency. Hyperzincemia was found in four of these patients. Magnetic resonance imaging of spine was normal in lone Cu deficient patients but showed T2 hyperintensity of posterior column in lone B12 or combined B12 and copper deficiency.
In cases of B12 deficiency myelopathy not responding to supplementation, copper deficiency must be sought at the earliest to avoid and treat persistent neurological disability.
维生素 B12 缺乏是引起后侧索脊髓病的一个公认原因。在印度次大陆，它可能与营养性铜缺乏并存，导致患者对 B12 补充的反应部分。因此，本研究旨在探讨低铜血症与 B12 缺乏的关系。
共纳入 23 例后侧索脊髓病（Romberg 征阳性）患者，检测维生素 B12、铜和锌水平，并随访 6 个月。
3 例患者仅发现铜缺乏，另有 3 例患者同时缺乏铜和维生素 B12。在所有这 6 例患者中，发现铜蓝蛋白和 24 小时尿铜均较低，提示饮食铜缺乏。这些患者中有 4 例出现高锌血症。在单纯铜缺乏的患者中，脊柱磁共振成像正常，但在单纯 B12 或 B12 和铜缺乏的患者中，后柱 T2 高信号。
对于对补充治疗无反应的 B12 缺乏性脊髓病，必须尽早寻找铜缺乏症，以避免和治疗持续的神经功能障碍。
