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Common neurological manifestations include: Paraesthesia (pins and needles) in the hands and feet Numbness and altered sensation Difficulty with balance and coordination (ataxia) Memory problems and cognitive impairment Mood changes, including depression and irritability In severe cases, visual disturbances and confusion These neurological features arise from demyelination of peripheral nerves and the spinal cord, a condition known as subacute combined degeneration when it affects the posterior and lateral columns of the spinal cord

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When B12 levels fall below optimal ranges, the integrity of this myelin sheath can become compromised, potentially leading to nerve damage known as peripheral neuropathy

monocytogenes (Hedberg, 2011)