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Paraneoplastic neurological syndromes (PNS) are diseases occurring as remote effects of tumors. Although many tumors have been associated with PNS, the most common include small cell lung cancer (SCLC), thymoma, neuroblastoma, ovarian, breast, testicular and Hodgkin lymphoma.
Tests generally appear in the order most useful for common clinical situations
| Test name: Comprehensive Metabolic Panel |
| ARUP #: 0020408 |
| Methodology: Refer to individual components |
| Use: Rule out underlying metabolic disorder as etiology of neurologic deficits |
| Test name: Cell Count, CSF |
| ARUP #: 0095018 |
| Methodology: Cell Count/Differential |
| Use: Rule out infectious process |
| Test name: CSF Bacterial Culture (Includes Gram Stain 0060101) |
| ARUP #: 0060106 |
| Methodology: Standard reference procedures for bacterial stain, aerobic culture, and identification |
| Use: Rule out presence of infectious etiology |
| Test name: Protein, Total, CSF |
| ARUP #: 0020514 |
| Methodology: Reflectance Spectrophotometry |
| Use: Part of infectious evaluation for neurologic deficit |
| Test name: Immunoglobulin G, CSF Index |
| ARUP #: 0050676 |
| Methodology: Quantitative Nephelometry |
| Use: Non-specific testing in neurologic evaluation May help rule out diseases such as multiple sclerosis |
| Test name: Oligoclonal Bands in CSF & Serum |
| ARUP #: 0081135 |
| Methodology: Qualitative Isoelectric Focusing/Immunofixation |
| Use: Non-specific testing in neurologic evaluation May help rule out diseases such as multiple sclerosis |
| Test name: Paraneoplastic Syndrome Antibody Panel with Reflex to ANNA Titer, PCCA Titer & Neuronal Immunoblot |
| ARUP #: 0051226 |
| Methodology: Refer to individual components |
| Use: Aid in the diagnosis of PNS associated with malignancy ANNA abs are screened by IFA; if IFA screen positive at 1:10; titer and immunoblot (Hu and Ri) will be added; if Purkinje cell screen positive at 1:20, titer and immunoblot (Yo) will be added |
| Limitations: Not recommended as a general screening test for lung, breast or gynecologic malignancies |
| Follow-up: Perform immunoblot assay to confirm positive results for ANNA-1, ANNA-2 or PCCA IFA test |
| Test name: Neuronal Nuclear Antibody (ANNA) IgG by IFA with Reflex to Titer & Immunoblot, Serum |
| ARUP #: 0050904 |
| Methodology: Semi-Quantitative Indirect Fluorescent Antibody/Qualitative Immunoblot |
| Use: Aid in the diagnosis of PNS associated with malignancy |
| Limitations: Not recommended as a general screening test for lung, breast or gynecologic malignancies |
| Follow-up: Consider ordering PCCA IFA with reflex to titer and confirmation by immunoblot |
| Test name: Neuronal Nuclear Antibody (ANNA) Titer IgG by IFA, Serum |
| ARUP #: 0050912 |
| Methodology: Semi-Quantitative Indirect Fluorescent Antibody |
| Use: Aid in the diagnosis of PNS associated with malignancy |
| Limitations: Not recommended as a general screening test for lung, breast or gynecologic malignancies |
| Follow-up: Perform immunoblot assay to confirm positive results for ANNA-1 or ANNA-2 |
| Test name: Neuronal Nuclear Antibodies (ANNA) IgG, Immunoblot, Serum |
| ARUP #: 0051088 |
| Methodology: Qualitative Immunoblot |
| Use: Aid in the diagnosis of PNS associated with malignancy |
| Limitations: Not recommended as a general screening test for lung, breast or gynecologic malignancies |
| Follow-up: Consider ordering PCCA IFA with reflex to titer and Western Blot |
| Test name: Neuronal Antibodies (Hu, Ri, Yo, Amphiphysin) IgG by Immunoblot |
| ARUP #: 0051090 |
| Methodology: Qualitative Immunoblot |
| Use: Aid in the diagnosis of PNS associated with malignancy Relatively low sensitivity; use when clinical suspicion for PNS is very high Amphiphysin antibodies are most useful in this test |
| Limitations: Not recommended as first-line test for neuronal antibodies (Hu, Ri, Yo, Amphiphysin) Presence of amphiphysin antibodies does not necessarily indicate the presence of a tumor; absence of these antibodies does not rule out PNS |
| Test name: Purkinje Cell Cytoplasmic Antibody by IFA with Reflex to Titer & Immunoblot |
| ARUP #: 0059444 |
| Methodology: Semi-Quantitative Indirect Fluorescent Antibody/Qualitative Immunoblot |
| Use: Aid in the diagnosis of PNS associated with malignancy |
| Test name: Voltage-Gated Calcium Channel (VGCC) Antibody |
| ARUP #: 0092628 |
| Methodology: Quantitative Radiobinding Assay |
| Use: Aid in the diagnosis of PNS associated with malignancy |
| Test name: Voltage-Gated Potassium Channel (VGKC) Antibody |
| ARUP #: 2004890 |
| Methodology: Quantitative Radiobinding Assay |
| Use: Aid in the diagnosis of PNS associated with malignancy |
| Test name: Purkinje Cell Cytoplasmic Antibody by IFA with Reflex to Titer & Western Blot, CSF |
| ARUP #: 0098510 |
| Methodology: Qualitative Immunofluorescence Assay/Quantitative Western Blot |
| Comments: If positive, titer and Western blot confirmation will be added |
| Test name: Neuronal Nuclear Antibody (ANNA) with Reflex to Titer and Western Blot, CSF |
| ARUP #: 0098761 |
| Methodology: |
| Comments: If positive result, titer and Western blot will be added |
| Test name: Neuronal Cell Antibodies, CSF |
| ARUP #: 0098726 |
| Methodology: Enzyme-Linked Immunosorbent Assay |
| Comments: |
| Test name: Neuronal Cell Antibodies, Serum |
| ARUP #: 0099465 |
| Methodology: Enzyme Immunoassay |
| Comments: |