![]() Normal daily dietary intake ranges from 5 to 50 μg, with normal plasma concentrations of <0.2 μg/L. Review of the literature suggests that increased levels of cobalt can interfere with metabolism in neurons and damage muscle fibers, providing possible pathological mechanisms for the patient’s spasticity.Ĭobalt is an essential trace element that has important roles in the production and regulation of red blood cells, platelets, and DNA as well as fatty acid synthesis and energy production. Reduction in the patient’s spasticity was associated with prosthesis revision and subsequent reduction in blood cobalt, suggesting that cobalt was involved in the pathogenesis or at minimum worsening of his spasticity given his concurrent MS. Concerns of high cobalt levels, confirmed via blood testing, led to revisions of both of his hip prosthesis, which alleviated his muscle spasms. To our knowledge, this is the first reported case of muscle spasticity associated with increased blood cobalt levels. Cobalt poisoning can arise from metal implants due to wear and tear on the metal implant surfaces, but implant deterioration has not yet been reported to cause muscle spasticity. A 45-year-old male patient with a medical history of multiple sclerosis (MS) and bilateral hip arthroplasty presented with spasticity that persisted despite administration of anti-spasmodic medication and intrathecal baclofen. ![]() Cobalt is known to produce a variety of symptoms in patients who accumulate a toxic amount in their blood. ![]()
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