RSS-Feed abonnieren
DOI: 10.1055/s-0032-1322583
Metabolic and Toxic Myelopathies
Publikationsverlauf
Publikationsdatum:
08. September 2012 (online)
Abstract
The myelopathies discussed in this article have an underlying metabolic or toxic etiology. They have many clinical, electrophysiologic, and neuropathologic similarities. Preferential involvement of the dorsal columns and/or corticospinal tracts is commonly seen. Variable degrees of peripheral nerve and/or optic nerve involvement may be present. In the presence of clinical or electrophysiologic evidence of peripheral nerve involvement, the term myeloneuropathy is commonly used.
The metabolic and toxic myelopathies discussed here are divided into three categories: disorders due to an identified nutrient deficiency such as the subacute combined degeneration of cobalamin/vitamin B12 or copper deficiency, disorders that have a geographical predilection and are due to a suspected toxin such as lathyrism, and disorders due to a possible toxin but without a geographical predilection such as hepatic myelopathy ([Table 1]).
-
References
- 1 Carmel R. Current concepts in cobalamin deficiency. Annu Rev Med 2000; 51: 357-375
- 2 Andrès E, Affenberger S, Vinzio S , et al. Food-cobalamin malabsorption in elderly patients: clinical manifestations and treatment. Am J Med 2005; 118 (10) 1154-1159
- 3 Carmel R, Green R, Rosenblatt DS, Watkins D. Update on cobalamin, folate, and homocysteine. Hematology (Am Soc Hematol Educ Program) 2003; 62-81
- 4 Juhasz-Pocsine K, Rudnicki SA, Archer RL, Harik SI. Neurologic complications of gastric bypass surgery for morbid obesity. Neurology 2007; 68 (21) 1843-1850
- 5 Kumar N. Neurological aspects of cobalamin (B12) deficiency. In: Biller J, ed. Handbook of Clinical Neurology: Systemic Diseases. Amsterdam: Elsevier; 2011. (in press)
- 6 Lindenbaum J, Healton EB, Savage DG , et al. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med 1988; 318 (26) 1720-1728
- 7 Healton EB, Savage DG, Brust JC, Garrett TJ, Lindenbaum J. Neurologic aspects of cobalamin deficiency. Medicine (Baltimore) 1991; 70 (4) 229-245
- 8 Carmel R, Melnyk S, James SJ. Cobalamin deficiency with and without neurologic abnormalities: differences in homocysteine and methionine metabolism. Blood 2003; 101 (8) 3302-3308
- 9 Saperstein DS, Wolfe GI, Gronseth GS , et al. Challenges in the identification of cobalamin-deficiency polyneuropathy. Arch Neurol 2003; 60 (9) 1296-1301
- 10 Locatelli ER, Laureno R, Ballard P, Mark AS. MRI in vitamin B12 deficiency myelopathy. Can J Neurol Sci 1999; 26 (1) 60-63
- 11 Bassi SS, Bulundwe KK, Greeff GP, Labuscagne JH, Gledhill RF. MRI of the spinal cord in myelopathy complicating vitamin B12 deficiency: two additional cases and a review of the literature. Neuroradiology 1999; 41 (4) 271-274
- 12 Karantanas AH, Markonis A, Bisbiyiannis G. Subacute combined degeneration of the spinal cord with involvement of the anterior columns: a new MRI finding. Neuroradiology 2000; 42 (2) 115-117
- 13 Su S, Libman RB, Diamond A, Sharfstein S. Infratentorial and supratentorial leukoencephalopathy associated with vitamin B12 deficiency. J Stroke Cerebrovasc Dis 2000; 9 (3) 136-138
- 14 Solomon LR. Cobalamin-responsive disorders in the ambulatory care setting: unreliability of cobalamin, methylmalonic acid, and homocysteine testing. Blood 2005; 105 (3) 978-985
- 15 Carmel R. How I treat cobalamin (vitamin B12) deficiency. Blood 2008; 112 (6) 2214-2221
- 16 Savage DG, Lindenbaum J, Stabler SP, Allen RH. Sensitivity of serum methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies. Am J Med 1994; 96 (3) 239-246
- 17 Green R, Kinsella LJ. Current concepts in the diagnosis of cobalamin deficiency. Neurology 1995; 45 (8) 1435-1440
- 18 Chanarin I, Metz J. Diagnosis of cobalamin deficiency: the old and the new. Br J Haematol 1997; 97 (4) 695-700
- 19 Andrès E, Fothergill H, Mecili M. Efficacy of oral cobalamin (vitamin B12) therapy. Expert Opin Pharmacother 2010; 11 (2) 249-256
- 20 Stabler SP. Screening the older population for cobalamin (vitamin B12) deficiency. J Am Geriatr Soc 1995; 43 (11) 1290-1297
- 21 Ng J, Frith R. Nanging. Lancet 2002; 360 (9330) 384
- 22 Kinsella LJ, Green R. 'Anesthesia paresthetica': nitrous oxide-induced cobalamin deficiency. Neurology 1995; 45 (8) 1608-1610
- 23 Marié RM, Le Biez E, Busson P , et al. Nitrous oxide anesthesia-associated myelopathy. Arch Neurol 2000; 57 (3) 380-382
- 24 Kieburtz KD, Giang DW, Schiffer RB, Vakil N. Abnormal vitamin B12 metabolism in human immunodeficiency virus infection. Association with neurological dysfunction. Arch Neurol 1991; 48 (3) 312-314
- 25 Di Rocco A, Werner P, Bottiglieri T , et al. Treatment of AIDS-associated myelopathy with L-methionine: a placebo-controlled study. Neurology 2004; 63 (7) 1270-1275
- 26 Green R, Miller JW. Folate deficiency beyond megaloblastic anemia: hyperhomocysteinemia and other manifestations of dysfunctional folate status. Semin Hematol 1999; 36 (1) 47-64
- 27 Reynolds EH. Benefits and risks of folic acid to the nervous system. J Neurol Neurosurg Psychiatry 2002; 72 (5) 567-571
- 28 Reynolds EH, Rothfeld P, Pincus JH. Neurological disease associated with folate deficiency. BMJ 1973; 2 (5863) 398-400
- 29 Parry TE. Folate responsive neuropathy. Presse Med 1994; 23 (3) 131-137
- 30 Reynolds EH. Benefits and risks of folic acid to the nervous system. J Neurol Neurosurg Psychiatry 2002; 72 (5) 567-571
- 31 Diaz-Arrastia R. Homocysteine and neurologic disease. Arch Neurol 2000; 57 (10) 1422-1427
- 32 Toole JF, Malinow MR, Chambless LE , et al. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial. [see comment] JAMA 2004; 291 (5) 565-575
- 33 Brouwer DA, Welten HT, Reijngoud DJ, van Doormaal JJ, Muskiet FA. Plasma folic acid cutoff value, derived from its relationship with homocyst(e)ine. Clin Chem 1998; 44 (7) 1545-1550
- 34 Lucock M, Yates Z. Measurement of red blood cell methylfolate. Lancet 2002; 360 (9338) 1021-1022 , author reply 1022
- 35 Stabler SP, Marcell PD, Podell ER, Allen RH, Savage DG, Lindenbaum J. Elevation of total homocysteine in the serum of patients with cobalamin or folate deficiency detected by capillary gas chromatography-mass spectrometry. J Clin Invest 1988; 81 (2) 466-474
- 36 Kumar N, McEvoy KM, Ahlskog JE. Myelopathy due to copper deficiency following gastrointestinal surgery. Arch Neurol 2003; 60 (12) 1782-1785
- 37 Kumar N, Ahlskog JE, Gross Jr JB. Acquired hypocupremia after gastric surgery. Clin Gastroenterol Hepatol 2004; 2 (12) 1074-1079
- 38 Winston GP, Jaiser SR. Copper deficiency myelopathy and subacute combined degeneration of the cord - why is the phenotype so similar?. Med Hypotheses 2008; 71 (2) 229-236
- 39 Kumar N, Gross Jr JB, Ahlskog JE. Myelopathy due to copper deficiency. Neurology 2003; 61 (2) 273-274
- 40 Nations SP, Boyer PJ, Love LA , et al. Denture cream: an unusual source of excess zinc, leading to hypocupremia and neurologic disease. Neurology 2008; 71 (9) 639-643
- 41 Hedera P, Peltier A, Fink JK, Wilcock S, London Z, Brewer GJ. Myelopolyneuropathy and pancytopenia due to copper deficiency and high zinc levels of unknown origin II. The denture cream is a primary source of excessive zinc. Neurotoxicology 2009; 30 (6) 996-999
- 42 Pawa S, Khalifa AJ, Ehrinpreis MN, Schiffer CA, Siddiqui FA. Zinc toxicity from massive and prolonged coin ingestion in an adult. Am J Med Sci 2008; 336 (5) 430-433
- 43 Yaldizli O, Johansson U, Gizewski ER, Maschke M. Copper deficiency myelopathy induced by repetitive parenteral zinc supplementation during chronic hemodialysis. J Neurol 2006; 253 (11) 1507-1509
- 44 Foubert-Samier A, Kazadi A, Rouanet M , et al. Axonal sensory motor neuropathy in copper-deficient Wilson's disease. Muscle Nerve 2009; 40 (2) 294-296
- 45 Halfdanarson TR, Kumar N, Hogan WJ, Murray JA. Copper deficiency in celiac disease. J Clin Gastroenterol 2009; 43 (2) 162-164
- 46 Goodman BP, Mistry DH, Pasha SF, Bosch PE. Copper deficiency myeloneuropathy due to occult celiac disease. Neurologist 2009; 15 (6) 355-356
- 47 Shike M. Copper in parenteral nutrition. Gastroenterology 2009; 137 (5, Suppl) S13-S17
- 48 Kumar N, Gross Jr JB, Ahlskog JE. Copper deficiency myelopathy produces a clinical picture like subacute combined degeneration. Neurology 2004; 63 (1) 33-39
- 49 Mercer JF, Llanos RM. Molecular and cellular aspects of copper transport in developing mammals. J Nutr 2003; 133 (5, Suppl 1) 1481S-1484S
- 50 Kumar N. Copper deficiency myelopathy (human swayback). Mayo Clin Proc 2006; 81 (10) 1371-1384
- 51 Prodan CI, Bottomley SS, Vincent AS, Cowan LD, Holland NR, Lind SE. Hypocupremia associated with prior vitamin B12 deficiency. Am J Hematol 2007; 82 (4) 288-290
- 52 Pineles SL, Wilson CA, Balcer LJ, Slater R, Galetta SL. Combined optic neuropathy and myelopathy secondary to copper deficiency. Surv Ophthalmol 2010; 55 (4) 386-392
- 53 Weihl CC, Lopate G. Motor neuron disease associated with copper deficiency. Muscle Nerve 2006; 34 (6) 789-793
- 54 Kumar N, Elliott MA, Hoyer JD, Harper Jr CM, Ahlskog JE, Phyliky RL. “Myelodysplasia,” myeloneuropathy, and copper deficiency. Mayo Clin Proc 2005; 80 (7) 943-946
- 55 Halfdanarson TR, Kumar N, Li CY, Phyliky RL, Hogan WJ. Hematological manifestations of copper deficiency: a retrospective review. Eur J Haematol 2008; 80 (6) 523-531
- 56 Kumar N, Ahlskog JE, Klein CJ, Port JD. Imaging features of copper deficiency myelopathy: a study of 25 cases. Neuroradiology 2006; 48 (2) 78-83
- 57 Ferrara JM, Skeen MB, Edwards NJ, Gray L, Massey EW. Subacute combined degeneration due to copper deficiency. J Neuroimaging 2007; 17 (4) 375-377
- 58 Kumar G, Goyal MK, Lucchese S, Dhand U. Copper deficiency myelopathy can also involve the brain stem. AJNR Am J Neuroradiol 2011; 32 (1) E14-E15 DOI: 10.3174/ajnr.A2261.
- 59 Goodman BP, Bosch EP, Ross MA, Hoffman-Snyder C, Dodick DD, Smith BE. Clinical and electrodiagnostic findings in copper deficiency myeloneuropathy. J Neurol Neurosurg Psychiatry 2009; 80 (5) 524-527
- 60 Kumar N, Butz JA, Burritt MF. Clinical significance of the laboratory determination of low serum copper in adults. Clin Chem Lab Med 2007; 45 (10) 1402-1410
- 61 Sokol RJ. Vitamin E deficiency and neurologic disease. Annu Rev Nutr 1988; 8: 351-373
- 62 Vorgerd M, Tegenthoff M, Kühne D, Malin JP. Spinal MRI in progressive myeloneuropathy associated with vitamin E deficiency. Neuroradiology 1996; 38 (Suppl. 01) S111-S113
- 63 Sokol RJ, Heubi JE, Iannaccone ST, Bove KE, Balistreri WF. Vitamin E deficiency with normal serum vitamin E concentrations in children with chronic cholestasis. N Engl J Med 1984; 310 (19) 1209-1212
- 64 Howlett WP, Brubaker GR, Mlingi N, Rosling H. Konzo, an epidemic upper motor neuron disease studied in Tanzania. Brain 1990; 113 (Pt 1) 223-235
- 65 Osuntokun BO. An ataxic neuropathy in Nigeria. A clinical, biochemical and electrophysiological study. Brain 1968; 91 (2) 215-248
- 66 Ludolph AC, Hugon J, Dwivedi MP, Schaumburg HH, Spencer PS. Studies on the aetiology and pathogenesis of motor neuron diseases. 1. Lathyrism: clinical findings in established cases. Brain 1987; 110 (Pt 1) 149-165
- 67 Misra UK, Nag D, Husain M, Newton G, Ray PK. Endemic fluorosis presenting as cervical cord compression. Arch Environ Health 1988; 43 (1) 18-21
- 68 Konagaya M, Matsumoto A, Takase S , et al. Clinical analysis of longstanding subacute myelo-optico-neuropathy: sequelae of clioquinol at 32 years after its ban. J Neurol Sci 2004; 218 (1–2) 85-90
- 69 Kumar N, Knopman DS. SMON, clioquinol, and copper. Postgrad Med J 2005; 81: 227
- 70 Schaumburg H, Herskovitz S. Copper deficiency myeloneuropathy: a clue to clioquinol-induced subacute myelo-optic neuropathy?. Neurology 2008; 71 (9) 622-623
- 71 Román GC, Spencer PS, Schoenberg BS. Tropical myeloneuropathies: the hidden endemias. Neurology 1985; 35 (8) 1158-1170
- 72 Román GC. An epidemic in Cuba of optic neuropathy, sensorineural deafness, peripheral sensory neuropathy and dorsolateral myeloneuropathy. J Neurol Sci 1994; 127 (1) 11-28
- 73 Araujo AQ, Silva MT. The HTLV-1 neurological complex. Lancet Neurol 2006; 5 (12) 1068-1076
- 74 Hahn AF, Feasby TE, Gilbert JJ. Paraparesis following intrathecal chemotherapy. Neurology 1983; 33 (8) 1032-1038
- 75 McLean DR, Clink HM, Ernst P , et al. Myelopathy after intrathecal chemotherapy. A case report with unique magnetic resonance imaging changes. [see comment] Cancer 1994; 73 (12) 3037-3040
- 76 Conn HO, Rössle M, Levy L, Glocker FX. Portosystemic myelopathy: spastic paraparesis after portosystemic shunting. Scand J Gastroenterol 2006; 41 (5) 619-625
- 77 Gospe Jr SM, Caruso RD, Clegg MS , et al. Paraparesis, hypermanganesaemia, and polycythaemia: a novel presentation of cirrhosis. Arch Dis Child 2000; 83 (5) 439-442
- 78 McCreary M, Emerman C, Hanna J, Simon J. Acute myelopathy following intranasal insufflation of heroin: a case report. Neurology 2000; 55 (2) 316-317
- 79 Nyffeler T, Stabba A, Sturzenegger M. Progressive myelopathy with selective involvement of the lateral and posterior columns after inhalation of heroin vapour. J Neurol 2003; 250 (4) 496-498
- 80 Senanayake N, Karalliedde L. Neurotoxic effects of organophosphorus insecticides. An intermediate syndrome. N Engl J Med 1987; 316 (13) 761-763
- 81 Lotti M, Becker CE, Aminoff MJ. Organophosphate polyneuropathy: pathogenesis and prevention. Neurology 1984; 34 (5) 658-662