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Many patients have successfully learnt to self-administer B 12 by intramuscular injection, which reduces both healthcare costs and burden on GP practices, and allows people who are B 12 deficient to optimise their treatment regimen.6566 Case example A man in his 70s presents with a nine month history of difficulty walking and climbing stairs, numbness and pain in his lower limbs, and paraesthesia in his hands

examples of non-hydrogen substituents includes halogen, C1-4 alkyl, halogen-substituted C1-4 alkyl, NR 9 R 10 , NR 11 R 12 , and CN

Clinical Presentation of Subacute Combined Degeneration in a Patient With Chronic B12 Deficiency