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deficiency causes demyelination affecting sensory and motor nerve pathways Common presentations include peripheral neuropathy (glove-and-stocking paraesthesia), unsteadiness, cognitive impairment, and mood changes Neurological symptoms can occur before anaemia develops and may not correlate with serum B12 levels UK treatment for neurological involvement requires hydroxocobalamin 1 mg intramuscularly on alternate days initially, then every two months Treatment should not be delayed whilst awaiting test results when neurological B12 deficiency is suspected, as delays risk permanent damage At-risk groups include older adults, vegans, post-bariatric surgery patients, long-term metformin users, and those exposed to nitrous oxide Table of Contents What Are the Neurological Symptoms of B12 Deficiency