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Ultrastructural changes at the axonal level observed by electron microscopy in addition to early degenerative changes included focal edema, axonal debris accumulation, fluid pocket formation, neurofibril breakdown, and axon-associated glial edema, which in some cases showed signs of gliosis

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Deficiency Risks and Who Is Most Affected Certain groups are at higher risk of deficiency, including: Vegetarians and vegans Adults over 50 with reduced stomach acid Patients with gut disorders such as Crohns or celiac disease Those taking long-term acid-reducing medications Symptoms of deficiency can include fatigue, pale skin, memory loss, depression, numbness, or tingling sensations