Neurology Lab Panels

Disclosure: For Reference Only. Please DO NOT order ALL labs. Tailor them according to your patient/s. For Education purposes only – Do not consider this as advise on specific cases

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

Biopsy: Skin

Other studies: Motor-sensory neuropathy panel (Pestronk), Muscle mitochondrial enzyme analysis (Pestronk), Muscle Glycogen pathway analysis (Pestronk)

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, Myositis panel (Oklahoma), EKG, Cardiac Echo, EMG/NCS with repetitive nerve stimulation, muscle biopsy.

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

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, Myositis panel (Oklahoma), EKG, Cardiac Echo, CSF evaluation. Mycoplasma

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

Autoimmune Panel

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

Paraneoplastic Panel

Serum: Test ID: PAVAL – Paraneoplastic, Autoantibody Evaluation, Serum

CSF: Test ID: PAC1 – Paraneoplastic, Autoantibody Evaluation, Spinal Fluid

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

Neuroaxis imaging w/wo Contrast

Hyper-Coaguable

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

Encephalopathy (Serum+/- CSF) Panel

Autoimmune Panel

Vasculitis Panel

CSF Panel

Paraneoplastic Panel

Cerebrospinal Fluid (CSF) Studies

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

Bacterial and Fungal Gram Stain and Culture, AFB Smear

Other: ACE, VDRL

Meningitis/Encephalitis Panel: Test ID: CSFME – Pathogen Panel, PCR, Spinal Fluid

If panel not available consider PCR:

HSV, VZV, EBV, CMV

West Nile, listeria, HTLV1, St Louis Encephalitis

MS Panel: Test ID: MSP2 : Multiple Sclerosis (MS) Profile, Serum and Spinal Fluid

Encephalopathy: Test ID: ENC1 : Encephalopathy, Autoimmune Evaluation, Spinal Fluid

Other CSF Studies: Creutzfeldt-Jakob disease (CJD): 14-3-3, tau proteins for CJD

Extra

Documented Opening and Closing Pressure

Documented Total CSF Fluid Drained –

Documented Color of CSF drainage and color change if present

Save CSF for future analysis for 30 Days

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