Myelopathy work-up
Screening tests
Serum
glucose, electrolytes, protein, calcium/phosphorus, uric acid, lactate and pyruvate, liver,
renal and thyroid
function tests
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