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Perfusion imaging techniques such as arterial spin labeling may identify early reductions in cerebral blood flow before structural lesions become apparent

Vitamin B12 supplied as cyanocobalamin or hydroxocobalamin acts through its coenzymes in many metabolic processes including the synthesis of myelin, essential lipoprotein for the integrity of the nervous and peripheral system (antineuritic action)

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UK guidance recommends hydroxocobalamin 1mg intramuscularly with dosing frequency determined by presence of neurological involvement