| Initial diagnostic workup |
Subsequent diagnostic workup |
Autoimmune & neural-specific antibody testing |
| Complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), erythrocyte sedimentation rate (ESR), C-reactive protein, renal function panel, liver enzymes, thyroid function tests, vitamin B12, calcium and ammonia levels. |
MRI/MRA to exclude vascular disease, demyelination and tumors. CT angiogram of neck and cerebral vessels to rule out vasculitis. Leptomeningeal biopsy in suspected cases of primary CNS vasculitis. |
Antithyroid antibodies: Antibodies to thyroid peroxidase (TPO), and thyroglobulin, thyrotropin receptor (TRAb). Anti-NH2-terminal of α-enolase (NAE) antibodies. |
| HIV, hepatitis and syphilis screen. |
Continuous EEG to rule out nonconvulsive status epilepticus. |
Systemic autoimmune workup: Antinuclear antibodies (ANA), double-stranded DNA (anti-dsDNA) antibodies, antineutrophil cytoplasmic antibodies (ANCA), anti ribonucleoprotein (anti-RNP), anti-Sjogren (anti-SSA, anti-SSB), anti-Smith, anti-Scl-70 antibodies, rheumatoid factor(RF) and anti-cyclic citrullinated peptide (CCP). |
| Urinalysis, chest x-ray and blood cultures. CT head to rule out bleeding and cerebral edema. Serum and urine toxicology screen and lead and heavy metal poisoning screen. Serum viscosity, C3, C4 and IgG4 level as needed. |
Lumbar Puncture fluid additional tests: Markers of elevated intrathecal IgG synthesis (myelin based protein, oligoclonal bands, IgG index, and synthesis rate). CSF 14-3-3 protein (for possible Creutzfeldt-Jakob disease). |
| Lumbar Puncture: Cell count and culture to rule out bacterial, viral and fungal infections. Save fluid from the lumbar puncture for additional tests as needed. |
CT scan of the chest, abdomen and pelvis to rule out mass lesions. Testicular ultrasound, mammogram, pelvic ultrasound, endoscopy, PET/CT scan as needed. |
Serum & CSF paraneoplastic and autoantibody panels; Mayo clinic laboratories test panels ID: PAVAL, ENC2 and FGAGM (Ganglioside (Asialo-GM1, GM1, GM2, GD1a, GD1b, and GQ1b) Antibodies). |
