Paraesthesia in Hands and Clumsiness

A 60-year-old female presented with a progressive onset of paraesthesia and numbness affecting her hands and upper limbs over the past few months. Her initial serum B12 vitamin level was borderline and she was started on substitution therapy, which did not alleviate her symptoms. In the last couple of weeks, the patient reported further exacerbation of her symptoms in the hands and arms upon neck flexion. She also mentioned clumsiness during daily activities, and fine motor tasks became challenging. Blood investigations, including follow up serum B12 and folate levels, were within normal limits this time.