Zinc containing dental fixative causing copper deficiency myelopathy.
Zinc containing dental fixative causing copper deficiency myelopathy.
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DOI：
10.1136/bcr-2017-219802
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发表时间：
2017-08-08
期刊：
影响因子：
0.9
通讯作者：
Murray, Rosanne
中科院分区：
文献类型：
--
作者：
Carroll, Liam Stuart;Abdul-Rahim, Azmil H;Murray, Rosanne
一名 62 岁男性，之前身体状况良好，6 个月以来下肢不稳、感觉异常、疼痛和虚弱恶化，导致他足不出户，被转诊至神经科诊所。检查显示上运动神经元模式下肢无力和本体感觉丧失。血清分析显示，铜蓝蛋白和铜水平降低，锌水平升高。脊柱成像显示 C2-C7 的背柱强度发生细微变化，经 3T MRI 证实。诊断为继发于长期使用含锌牙科固定糊剂的铜缺乏性脊髓神经病。停止使用糊剂并开始补充铜。强化物理治疗未能解决症状。尽管症状已经停止进展，但患者仍然使用轮椅。在病程早期及时识别和治疗高锌血症引起的低铜血症可能可以预防任何不可逆的神经功能缺损。
A 62-year-old male, previously well, was referred to neurology clinic following 6months history of worsening lower limbs instability, paraesthesia, pain and weakness rendering him housebound. Examination revealed upper motor neuron pattern of weakness of the lower limbs and loss of proprioception. Serum analysis revealed reduced caeruloplasmin and copper levels with raised zinc. Spinal imaging revealed subtle dorsal column intensity changes in C2-C7, confirmed with 3T MRI. A copper deficiency myeloneuropathy was diagnosed secondary to chronic use of a zinc-containing dental fixative paste. The paste was discontinued and a copper supplementation was started. Resolution of symptoms was not achieved with intensive physiotherapy. The patient remains a wheelchair user though progression of symptoms has halted. Prompt recognition and treatment of hyperzincaemia-induced hypocupraemia earlier in the disease course may have prevented any irreversible neurological deficit.