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[6] [7] Common neurological presentations include: Peripheral neuropathy tingling, numbness, or pins-and-needles sensations (paraesthesia), typically beginning in the feet and hands in a symmetrical 'glove and stocking' distribution Gait disturbances unsteadiness, difficulty walking, or loss of balance due to proprioceptive impairment Cognitive changes memory problems, confusion, difficulty concentrating, or 'brain fog' Mood alterations depression, irritability, or personality changes Weakness muscle weakness or fatigue affecting daily activities Visual disturbances rarely, optic neuropathy causing blurred or reduced vision In more severe cases, patients may develop subacute combined degeneration of the spinal cord , a serious condition affecting the posterior and lateral columns

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this is often cited as 80-95% or near-complete systemic delivery, because it bypasses degradation and enters the bloodstream directly

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