From the Guidelines
A neurological workup should include brain imaging and cerebrospinal fluid (CSF) analysis as the initial steps, followed by other targeted tests based on clinical suspicion, as recommended by recent guidelines 1. When suspecting neurological disorders, a comprehensive workup is essential to confirm the diagnosis and rule out other possibilities.
Initial Steps
The workup typically starts with:
- Brain imaging to evaluate structural abnormalities
- Cerebrospinal fluid (CSF) analysis to assess for infections, autoimmune conditions, or other abnormalities, as suggested by the study on autoimmune encephalitis 1
Additional Tests
Other key laboratory tests may include:
- Blood tests such as complete blood count (CBC), comprehensive metabolic panel, and thyroid function tests
- Vitamin B12 and folate levels to assess for deficiencies that can cause neurological symptoms
- Inflammatory markers like ESR and CRP to identify inflammatory conditions
- Specific tests like autoimmune panels, heavy metal screening, and genetic testing, depending on the suspected diagnosis
- Cerebrospinal fluid (CSF) analysis via lumbar puncture for evaluating infections, autoimmune conditions, and certain dementias
Specialized Tests
Additional specialized tests might be ordered based on clinical suspicion, including:
- Paraneoplastic panels to screen for cancer-related neurological disorders
- HIV testing when immunocompromise is suspected
- Drug levels when medication toxicity is a concern The specific tests ordered depend on the patient's symptoms, medical history, and suspected diagnosis, with the neurologist tailoring the workup accordingly, as outlined in the proposed best practice recommendations for diagnosis and acute management of autoimmune encephalitis 1.
From the Research
Laboratory Tests for Neurological Workup
The following laboratory tests are considered for a neurological workup:
- Blood cell count
- Thyroid function tests
- Renal function tests
- Liver function tests
- Blood glucose levels
- HbA1c
- Vitamin-B12
- Immunofixation 2 These tests are recommended as basic screening tests for neuropathies and should be chosen according to the individual and family history, clinical presentation, and electrophysiological findings.
Additional Laboratory Investigations
Other laboratory investigations may be carried out if a specific phenotype is present or if unexpected changes of the disease course occur, such as:
- Serologic testing for Lyme disease 3
- Tests for hereditary neuropathies It is recommended to refer patients to a neuromuscular center if basic laboratory parameters fail to uncover the etiology 2.
Reference Laboratory Testing
Reference laboratory testing plays a critical role in the diagnosis and monitoring of patients with neurologic disorders, and an increasing number of essential but esoteric tests are performed at reference laboratories or other outside health care facilities 4.