Faculty of Medicine, University of Southampton, Southampton, UK.
Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
BMJ Case Rep. 2021 Jul 21;14(7):e239375. doi: 10.1136/bcr-2020-239375.
A 67-year-old man presented with 5 months of worsening memory impairment and sensory gait ataxia on the background of symptomatic anaemia. He experienced falls, agitation and became socially withdrawn over 3 weeks, resulting in hospital admission. On examination, he had sensory gait ataxia consistent with a dorsal column syndrome. He scored 13/30 on the Montreal Cognitive Assessment. Serum analysis showed normocytic anaemia and leucopenia, severe hypocupraemia, reduced caeruloplasmin and normal zinc levels. Overuse of zinc-containing denture cream was the cause of excess zinc ingestion and resultant copper deficiency, leading to blood dyscrasia and myelopathy. The cream was withdrawn and intravenous and then oral copper supplementation was implemented. Direct questions with regard to excess zinc in the diet and serological testing of copper and zinc should be considered in any patient with a dorsal column syndrome, particularly with concurrent anaemia. Copper deficiency may also have a role in exacerbating pre-existing cognitive impairment.
一位 67 岁男性，因症状性贫血出现 5 个月的记忆力减退和感觉性共济失调步态，伴跌倒、激越和社会退缩，3 周后出现这些症状并入院。检查发现感觉性共济失调步态符合后柱综合征。他在蒙特利尔认知评估中得分为 13/30。血清分析显示正细胞性贫血和白细胞减少症、严重低铜血症、铜蓝蛋白减少和正常锌水平。过量使用含锌义齿膏是摄入过量锌和导致铜缺乏的原因，导致血液异常和脊髓病。停用义齿膏并实施静脉和口服铜补充。任何患有后柱综合征的患者，特别是同时存在贫血的患者，都应考虑有关饮食中过量锌和铜、锌血清学检测的直接问题。铜缺乏也可能加剧先前存在的认知障碍。
