Myelopathy work-up

 

Screening tests

Serum glucose, electrolytes, protein, calcium/phosphorus, uric acid, lactate and pyruvate, liver, renal and thyroid function tests, blood gasses

CBC, ESR, CRP

RPR, TPHA

Chest X-ray

MRI spinal cord and brain (with gadolinium contrast)

Schirmer test

 

Specific investigations

Blood/serum

ANA, ACE, c- and p-ANCA, LE cels, RF, anti-Ro (SS-A) and anti-La (SS-B), C3 and C4, antiphospholipid antibodies (anticardiolipin, Russel Viper veno time, partial thromboplastin time), immunoelectrophoresis.

Serology: HSV, VZV, HTLV-1, CMV, EBV, enterovirus, Hep A/B/C, HIV, CEE, mumps, measles, rubella, coxsackie virus, schistosomal ELISA, B. burgerdorferi, Chlamydia, Legionella, M. pneumonia.

Urine

proteinuria, immunoelectrophoresis.

CSF

Lactate and pyruvate (mitochondrial disease), oligoclonal bands (MS), IgG index

Serology: PCR for HSV-1 and -2, HHV-6, VZV, CMV, HTLV-1, EBV, enterovirus, HIV, B. burgerdorferi, VDRL

Acid-fast bacilli smear, fungal and TB culture.

Neurophysiology

EMG, NCVs, EEG, VEP, SSEP

Biopsy

Lip/salivary gland biopsy

Genetic testing

Mitochondrial mutation analysis

 

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