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Initial cranial imaging ruled out multiple sclerosis and stroke

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Intravenous use can be very effective, and doesn't cause diarrhea by this route, but this agent must be given extremely carefully, since an error in dosing can shut down the bone marrows production of blood cells, and potentially be fatal

These patients who do not fit the criteria but who remain undiagnosed B12 deficient patients become very expensive for the NHS to look after