Spastic Paraplegia and Ataxia in a Welder. (4th October 2022)

• Record Type: Journal Article
• Authors: Mumoli, Laura; Vescio, Virginia; Bosco, Domenico
• Is Part Of: Neurology. Volume 99:Number 14(2022)
• Page Start: 612
• Page End: 613
• Publication Date: 2022-10-04
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000201107
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : A 51-year-old welder (nonsmoker) developed subacute lower paresthesias and progressive spastic paraplegia and ataxia. Symptoms appeared 10 days after the first zinc exposure in the yacht construction site (8-hour day/40 days in a confined space with face shield only). Examination revealed loss of vibratory sensation, spasticity, hyperreflexia, and sensory ataxia. Serum heavy metals (Cu 1 mg/L and Pb 4, 22 μg/L), B-complex vitamins, and paraneoplastics on serum and CSF were unremarkable. The elevated zinc level (137 μg/dL) was found. Spinal MRI showed combined degeneration (Figure). Myelopathy in zinc smelter workers was reported in the 19th century 1 and recently rediscovered in excessive zinc ingestion. Copper secondary deficiency is hypothesized even if the normal copper serum level is reported. 2 Two months later, copper became low (0.8 mg/L), a time-dependent process might explain late copper deficiency in our case. Symptoms ameliorated 4 months later with normalization of serum zinc/copper levels.