Neurology Lab Panels

Fatigue Panel Neuropathy Panel Myopathy Panel Altered Mental Status Cerebrospinal Fluid (CSF) Studies Uncommon Causes of Stroke Hyper-Coaguable Panel Other Consider adding Vasculitis Panel Autoimmune Panel Paraneoplastic Panel Mayo Clinic Panels

Fatigue Panel

CBC, CMP, TSH, T3, T4, Cortisol, Folate, Vitamins Bl, B2, B6, B12, MMA, Homocysteine, Vitamin D, Serum ferritin, CK, aldolase, Lactate, pyruvate, Carnitine and acyl-carnitine levels, Long-chain fatty acids, Very Long-chain fatty acids, Medium chain fatty acids, short chain fatty acids, urine organic acids, Serum amino acids, CoQl0 level, AChR abs, MuSK abs, VGKC, Striational abs, Skin Biopsy, EMG/NCS with repetitive nerve stimulation, ABG, Carbon monoxide level, EKG, Cardiac Echo

Other studies: Muscle Biopsy, Muscle mitochondrial enzyme analysis (Pestronk), Muscle Glycogen pathway analysis (Pestronk)

Neuropathy Panel

CBC, CMP, TSH, T3, T4, Folate, HgbAlc, Vitamins Bl, B2, B6, B12, MMA, Homocysteine, Vitamin D, Serum ferritin, Lactate, pyruvate, Carnitine and acyl-carnitine levels, CoQlO level, ANA, RF, ENA, ESR, CRP, Serum ACE level, Serum copper, serum or whole blood zinc, ANCA, LFT, HIV, Hepatitis panel, RPR, UPEP, SPEP, IFE, Quantitative Immunoglobulins, C04/C08 counts. SS-A and SS-B Antibodies, Cryoglobulins, Myelin Associated Glycoprotein (MAG) Antibody, Ganglioside (GM1, GD1b, and GQ1b) Antibodies.

Procedures:

EMG/NCS, muscle/nerve biopsy

Skin Biopsy

Pestronk:

Motor-sensory neuropathy panel

Muscle mitochondrial enzyme analysis

Muscle Glycogen pathway analysis

neuromuscular.wustl.edu

https://neuromuscular.wustl.edu/over/labdis.html

Myopathy Panel

CBC, CMP, TSH, T3, T4, Vitamins Bl, B2, B6, B12, MMA, Homocysteine, Vitamin D, Lactate, pyruvate, Long-chain fatty acids, Very Long-chain fatty acids, Medium chain fatty acids, short chain fatty acids, Urine organic acids, serum amino acids, CK, aldolase, Carnitine and acyl-carnitine levels, CoQlO level, Serum ACE level, ANA, RF, ENA, ESR, CRP, ANCA, LFT, HIV, Hepatitis panel, RPR, UPEP, SPEP, IFE, Quantitative Immunoglobulins, C04/C08 counts, EKG, Cardiac Echo, EMG/NCS with repetitive nerve stimulation, muscle biopsy.

Pestrronk

Muscle mitochondrial enzyme analysis (Pestronk)

Muscle Glycogen pathway analysis (Pestronk)

Neuromuscular Clinical Laboratory

Testing at Washington University Laboratory: Specific tests Requisition forms & Information Serum (Antibody & Antigen) Sending samples: Instructions Biopsies: Muscle, Nerve & Skin Muscle instructions Freezing; Other Nerve instructions General; Surgery; Freezing; Other technical Skin instructions Antibodies General principles Classification Binding to oligosaccharides Glycoproteins & Glycolipids Specific types Testing methods Survey

https://neuromuscular.wustl.edu/over/labdis.html

Myositis panel (Oklahoma)

Forms

Myositis Testing Forms Clinical Immunology Requisition - PDF format Clinical Immunology Requisition - Word format Specimen Collection/Handling/Shipping- PDF format Specimen Collection/Handling/Shipping- Word format Price List with CPT Codes CAP Accreditation CLIA Certification

https://omrf.org/research-faculty/core-facilities/myositis-testing/myositis-testing-forms/

Altered Mental Status

CBC, CMP, Urine Drug screen, Blood alcohol level, Serum drug screen, Ammonia, TSH, T3, T4, Vitamins Bl, B2, B6, B12, MMA, Homocysteine, Vitamin D, Lactate, pyruvate, Long-chain fatty acids, Very Long-chain fatty acids, Medium chain fatty acids, short chain fatty acids, urine organic acids, serum amino acids, CK, aldolase, Carnitine and acyl-carnitine levels, CoQ10 level, serum ACE level, ANA, RF, ENA, ESR, CRP, ANCA, LFT, HIV, Hepatitis panel, HSV PCR, RPR, UPEP, SPEP, IFE, Quantitative Immunoglobulins, CD4/CD8 counts, EKG, Cardiac Echo, CSF evaluation. Mycoplasma

Encephalopathy Autoimmune Evaluation Algorithm, Serum

Encephalopathy Autoimmune Evaluation Algorithm, Spinal Fluid

Cerebrospinal Fluid (CSF) Studies

*** Urgent/NonUrgent Lumbar Punture

Cell Count, Protein, Glucose Tube #1 and #4

Bacterial and Fungal Gram Stain and Culture, AFB Smear

Other: ACE, VDRL

Meningitis/Encephalitis Panel

Encephalopathy, Autoimmune Evaluation, Spinal Fluid

MS Panel: Multiple Sclerosis (MS) Profile, Serum and Spinal Fluid

Document Opening and Closing Pressure

Document total CSF Fluid Drained

Documented Color of CSF drainage and color change if present

Save CSF for future analysis for 30 Days

Uncommon Causes of Stroke

Given the patients age is less than 55 with absence of typical risk factors, Patient is eligible for stoke in young workup to look for uncommon causes of stroke.

Hypercoagulable Panel: Cardiolipin Antibody Panel, Lupus Anticoagulant, Protein S Activity, Protein C Activity, Antithrombin Ill Activity, Methylenetetrahydrofolate reductase (MTHFR), DNA, Activated Protein C Resistance, with Reflex, Hemoglobin Electrophoresis, Sickling Screen w/o Reflex (if indicated), Prothrombin Genotype, Beta 2 Glycoprotein Panel, Factor VIII Assay, Cryoglobulin Qual, Cryofibrinogen

Autoimmune Panel: ANA, RF, ENA, ESR, CRP, ANCA, c-ANCA, p-ANCA, UPEP, SPEP, IFE

Vasculitis Panel: RPR, ANA, RF, ENA, ESR, CRP, Serum ACE level, ANCA, HIV, Hepatitis panel, Myeloperoxidase and Protease 3 AB , Complement Levels (C3 & C4), Lyme Disease by PCR, IFE Serum w/IgG,A,M & Kappa/Lambda Free Light Chain

Paraneoplastic Panel Serum

Hyper-Coaguable Panel

Cardiolipin AB Panel, Lupus Anticoagulant, Protein S, Protein C Activity, Activated Protein C Resistance Screen Only W/Reflex, Antithrombin III Activity, Homocysteine Total, Fibrinogen Activity, ANA Screen with Reflex IFA, Lipoprotein A, Protein Electrophoresis Serum, Hemoglobin Electrophoresis , Sickling Screen w/o Reflex, Prothrombin Genotype, Sedimentation Rate Westergren, C Reactive Protein, RPR , Complement Levels (C3 & C4), D Dimer Quantitative , Beta-2 Glycoprotein Panel, CRP (C Reactive Protein) High Sensitivity, Factor 8 Assay, Cryoglobulin Qual, Cryofibrinogen

Other

Blood Cultures x 2 (3 days)

Peripheral Smear (Sickle)

Transesophageal Echo

Bil Lower Ext Dopplers

Pelvic MRA (pelvic vein thrombosis)

Digital subtraction Angiogram

CT Chest, Abdomen and Pelvis w/wo Contrast (Malignancy Protocol)

Consider adding

Autoimmune Panel

Vasculitis Panel

Paraneoplastic Panel

CSF Panel

Encephalopathy (Serum+/- CSF) Panel

Vasculitis Panel

RPR, ANA, RF, ENA, ESR, CRP, Serum ACE level, ANCA, HIV, Hepatitis panel, Myeloperoxidase and Protease 3 AB , Complement Levels (C3 & C4), Lyme Disease by PCR, IFE Serum w/IgG,A,M & Kappa/Lambda Free Light Chain