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It is actually one of the symptoms of pernicious anemia that people may notice first and is a symptom that may respond quickly to B12 supplementation

Day 9: Uros Island + Taquile Full Day Breakfast at the Hotel The ninth day is dedicated to exploring Lake Titicaca, the highest navigable body of water in the world located at 3,800 masl, shared by Peru and Bolivia and considered sacred by the Andean and Inca cultures since pre-Columbian times

(PubMed) Li S, Guo Y, Men J, Fu H, Xu T

[55] If nervous system damage is present and blood testing is inconclusive, a lumbar puncture may be carried out to measure cerebrospinal fluid B 12 levels

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