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The spectrum of transverse myelitis (TM) disorders includes neuromyelitis optica (NMO), multiple sclerosis (MS), longitudinally extensive spinal cord lesions/transverse myelitis (LESCL/LETM), optic spinal MS (OSMS), acute disseminated encephalomyelitis (ADEM), acute complete TM (ACTM), and acute partial TM (APTM).
NMO (also known as Devic disease, Devic syndrome, or Devic neuromyelitis optica) is an acquired demyelinating disease of the central nervous system that may mimic MS.
Tests generally appear in the order most useful for common clinical situations
| Test name: CBC with Platelet Count & Automated Differential |
| ARUP #: 0040003 |
| Methodology: Automated Cell Count with Flow Cell Differential |
| Use: Rule out infectious process |
| Test name: Sedimentation Rate, Westergren (ESR) |
| ARUP #: 0040325 |
| Methodology: Westergren |
| Use: May be helpful in assessing inflammatory process |
| Test name: C-Reactive Protein |
| ARUP #: 0050180 |
| Methodology: Quantitative Immunoturbidimetric |
| Use: May be helpful in assessing inflammatory process |
| Test name: Anti-Nuclear Antibodies (ANA), IgG by ELISA with Reflex to ANA, IgG by IFA |
| ARUP #: 0050080 |
| Methodology: Qualitative Enzyme-Linked Immunosorbent Assay (ELISA)/Semi-Quantitative Indirect Fluorescent Antibody (IFA) |
| Use: First-line test for connective tissue disease screening All ELISA results reported as detected are further tested by IFA ANA ELISA screen is designed to detect antibodies against dsDNA, histone, SS-A (Ro), SS-B (La), Smith, snRNP/Sm, Scl-70, Jo-1, centromere, and an extract of lysed HEp-2 cells |
| Limitations: ANA ELISA assays have been reported to have lower sensitivities for antibodies associated with nucleolar and specked ANA-IFA patterns |
| Test name: Anti-Neutrophil Cytoplasmic Antibody with Reflex to Titer and MPO/PR-3 Antibodies |
| ARUP #: 2002068 |
| Methodology: Semi-Quantitative Indirect Fluorescent Antibody/Semi-Quantitative Multi-Analyte Fluorescent Detection |
| Use: Differentially diagnose systemic vasculitic syndromes If screen is positive, titer and MPO/PR-3 antibodies testing will be added to aid in antibody determination |
| Test name: Angiotensin Converting Enzyme, Serum |
| ARUP #: 0080001 |
| Methodology: Quantitative Enzymatic |
| Use: May be helpful in evaluation for neurosarcoidosis |
| Test name: Vitamin B12 |
| ARUP #: 0070150 |
| Methodology: Quantitative Chemiluminescent Immunoassay |
| Use: Rule out B12 deficiency |
| Test name: Treponema pallidum (Rapid Plasma Reagin) with Reflex to Titer |
| ARUP #: 0050471 |
| Methodology: Semi-Quantitative Charcoal Agglutination |
| Use: Rule out syphilis |
| Test name: Cell Count, CSF |
| ARUP #: 0095018 |
| Methodology: Cell Count/Differential |
| Use: May be helpful in differentiating infectious vs. inflammatory process in the CNS |
| Test name: Protein Electrophoresis, CSF |
| ARUP #: 0050590 |
| Methodology: Quantitative Electrophoresis |
| Use: Assist in the clinical assessment of suspected MS |
| Test name: Oligoclonal Bands in CSF and Serum |
| ARUP #: 0081135 |
| Methodology: Qualitative Isoelectric Focusing/Immunofixation |
| Use: Assist in the clinical assessment of suspected MS |
| Limitations: Isoelectric focusing and immunofixation is considered to be the gold standard test for the detection of oligoclonal bands in CSF MBP will increase in patients with head trauma or anoxic brain damage |
| Test name: Aquaporin-4 Receptor Antibody |
| ARUP #: 2003036 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Use: Confirm NMO Assess disease progression |
| Limitations: Presence of AQP4 antibodies should be used in conjunction with diagnostic criteria for NMO; positive AQP4 antibody results should not be used as sole diagnosis of NMO Absence of marker does not rule out NMO |