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Rather, some cancers may cause secondary elevation of B12 through various mechanisms

10.1126/science.3872478 87 GiulianD.WoodwardJ.YoungD

In the CNS, thiamine deficiency can lead to Wernickes encephalopathy, characterized by nystagmus, ophthalmoplegia, mental status changes, and unsteady stance and gait, due to apoptotic cell death in sensitive brain areas, mainly areas with high metabolic requirement, causing symmetrically distributed lesions among structures such as the third and fourth ventricles, besides dorsomedial thalamus (, , )