Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid

Alphabetical Test listing

Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid-12689

Serum is the preferred specimen and is more sensitive for all antibodies except for NMDA and GFAP for which CSF is somewhat more sensitive.

Test name:

Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid

Test number:

12689

Excellian order number:

LAB12689

Abbreviation:

ENC1

Alternate names:

Behavioral change
Confusion
ENCEC
Encephalitis
Glutamic Acid Decarboxylase (GAD65)
Leucine-Rich Glioma Inactivated Protein-1 IgG
Limbic encephalitis
metabotropic glutamate receptor 1
Psychosis

Tests included:

Encephalopathy, Interpretation, S
AMPA-R Ab CBA, S
Amphiphysin Ab, S
Anti-Glial Nuclear Ab, Type 1
Anti-Neuronal Nuclear Ab, Type 1
Anti-Neuronal Nuclear Ab, Type 2
Anti-Neuronal Nuclear Ab, Type 3
CASPR2-IgG CBA, S
CRMP-5-IgG, S
DPPX Ab IFA, S
GABA-B-R Ab CBA, S
GAD65 Ab Assay, S
GFAP IFA, S
IgLON5 IFA, S
LGI1-IgG CBA, S
mGluR1 Ab IFA, S
Neurochondrin IFA, S
NIF IFA, S
NMDA-R Ab CBA, S
Purkinje Cell Cytoplasmic Ab Type 1
Purkinje Cell Cytoplasmic Ab Type 2
Purkinje Cell Cytoplasmic Ab Type Tr
Septin-7 IFA, S

For reflex tests, see algorithm in Clinical and Interpretive info tab

Useful for:

Evaluating new onset encephalopathy (noninfectious or metabolic) comprising confusional states, psychosis, delirium, memory loss, hallucinations, movement disorders, sensory or motor complaints, seizures, dyssomnias, ataxias, nausea, vomiting, inappropriate antidiuresis, coma, dysautonomias, or hypoventilation in spinal fluid specimens

The following accompaniments should increase of suspicion for autoimmune encephalopathy:
- Headache
- Autoimmune stigmata (personal or family history or signs of diabetes mellitus, thyroid disorder, vitiligo, poliosis [premature graying], myasthenia gravis, rheumatoid arthritis, systemic lupus erythematosus)
- History of cancer
- Smoking history (20+ pack years) or other cancer risk factors
- Inflammatory cerebral spinal fluid (or isolated protein elevation)
- Neuroimaging signs suggesting inflammation
Evaluating limbic encephalitis (noninfectious)
Directing a focused search for cancer
Investigating encephalopathy appearing in the course or wake of cancer therapy and not explainable by metastasis or drug effect

Limitations:

Serum is the preferred specimen and is more sensitive for all antibodies except for NMDA and GFAP for which CSF is somewhat more sensitive.

Specimen type:

Cerebrospinal fluid (CSF)

Collection container:

Sterile vial/container

Volume:

4.0 mL

Minimum volume:

2.0 mL

Transport container:

Screw-capped polypropylene vial/tube, sterile (Mayo)

Transport and stability:

Refrigerated (preferred) - 28 days

Frozen - 28 days

Ambient - 72 hrs

Reason for rejection:

Gross hemolysis
Gross lipemia
Gross icterus

Performing lab:

Mayo Clinic Laboratories (ENC2): R-MM

Days set up:

Daily

TAT:

8 - 12 days

Method:

Immunofluorescence Assay (IFA), Cell Binding Assay (CBA), Western Blot (WB), Radioimmunoassay (RIA) and Immunoblot (IB)

Reference ranges:

See report

Clinical information:

Utilization guidelines for neurologic autoimmune panels

CPT codes:

86255 x 21
86341

Additional CPT codes (if appropriate):
84182-AGNBS
86256 AGNTS
86255-AINCS
86256-AMPIS
86256 APHTS
84182-AMIBS
84182-AN1BS
86256 AN1TS
84182-AN2BS
86256 AN2TS
86256 AN3TS
86256 CRMTS
84182-CRMWS
86255-DPPCS
86256-DPPTS
86256-GABIS
86255-GFACS
86256-GFATS
86255-IG5CS
86256-IG5TS
86255-GL1CS
86256-GL1TS
86255 NCDCS
86256 NCDTS
86255-NFHCS
86256-NIFTS
86255-NFLCS
86256-NMDIS
84182-PC1BS
86256 PC1TS
86256 PC2TS
84182-PCTBS
86256 PCTTS
86255 SP7CS
86256 SP7TS

Date created:

11/18/2014

Revised date:

02/01/2024

Review date:

01/02/2024