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Encephalopathy Paraneoplastic Evaluation, CSF
MessageSendout, Mayo test code: ENC2
Test Code
LAB234005
Alias/See Also
AMPA-R Antibody CBA
Amphiphysin Antibody
Anti-Glial Nuclear Antibody, Type 1
Anti-Neuronal Nuclear Antibody, Type 1
Anti-Neuronal Nuclear Antibody, Type 2
Anti-Neuronal Nuclear Antibody, Type 3
Behavioral Change
CASPR2-IgG
Confusion
Contactin-Associated Protein-Like-2 (CASPR2)-IgG
CRMP-5-IgG
DPPX
dipeptidyl aminopeptidase-like protein 6
ENCEC
Encephalitis
GABA-B-R Antibody CBA
Glutamic Acid Decarboxylase (GAD65)
Leucine-Rich Glioma Inactivated Protein-1 IgG
LGI1-IgG
metabotropic glutamate receptor 1
mGluR1
NMDA-R Antibody CBA
Psychosis
Purkinje Cell Cytoplasmic Antibody, Type 1
Purkinje Cell Cytoplasmic Antibody, Type 2
Purkinje Cell Cytoplasmic Antibody, Type Tr
Limbic encephalitis
Neurochondrin
Septin-7
ENC2
Amphiphysin Antibody
Anti-Glial Nuclear Antibody, Type 1
Anti-Neuronal Nuclear Antibody, Type 1
Anti-Neuronal Nuclear Antibody, Type 2
Anti-Neuronal Nuclear Antibody, Type 3
Behavioral Change
CASPR2-IgG
Confusion
Contactin-Associated Protein-Like-2 (CASPR2)-IgG
CRMP-5-IgG
DPPX
dipeptidyl aminopeptidase-like protein 6
ENCEC
Encephalitis
GABA-B-R Antibody CBA
Glutamic Acid Decarboxylase (GAD65)
Leucine-Rich Glioma Inactivated Protein-1 IgG
LGI1-IgG
metabotropic glutamate receptor 1
mGluR1
NMDA-R Antibody CBA
Psychosis
Purkinje Cell Cytoplasmic Antibody, Type 1
Purkinje Cell Cytoplasmic Antibody, Type 2
Purkinje Cell Cytoplasmic Antibody, Type Tr
Limbic encephalitis
Neurochondrin
Septin-7
ENC2
CPT Codes
86255 x21, 86341 x1
Includes
If client requests or if the immunofluorescence (IFA) patterns suggest collapsin response-mediator protein-5-IgG (CRMP-5-IgG), then CRMP-5-IgG IFA titer and CRMP-5-IgG Western blot will be performed at an additional charge.
If the IFA patterns suggest amphiphysin antibody, then amphiphysin IFA titer and amphiphysin immunoblot will be performed at an additional charge.
If the IFA pattern suggests antiglial nuclear antibody (AGNA-1), then AGNA-1 IFA titer and AGNA-1 immunoblot will be performed at an additional charge.
If the IFA pattern suggests antineuronal nuclear antibody type 1 (ANNA-1), then ANNA-1 IFA titer, ANNA-1 immunoblot, and ANNA-2 immunoblot will be performed at an additional charge.
If the IFA pattern suggests ANNA-2 antibody, then ANNA-2 IFA titer, ANNA-1 immunoblot, and ANNA-2 immunoblot will be performed at an additional charge.
If the IFA pattern suggests Purkinje cytoplasmic antibody type 1 (PCA-1), then PCA-1 IFA titer and PCA-1 immunoblot will be performed at an additional charge.
If the IFA pattern suggests PCA-2 antibody, then PCA-2 IFA titer will be performed at an additional charge.
If the IFA pattern suggests PCA-Tr antibody, then PCA-Tr IFA titer and PCA-Tr immunoblot will be performed at an additional charge.
If the IFA pattern suggests IgLON5 antibody, then IgLON5 IFA titer and IgLON5 cell-binding assay (CBA) will be performed at an additional charge.
If AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid) receptor antibody CBA is positive, then AMPA-receptor antibody IFA titer assay will be performed at an additional charge.
If gamma-aminobutyric acid B (GABA-B) receptor antibody CBA is positive, then GABA-B-receptor antibody IFA titer assay will be performed at an additional charge.
If the IFA pattern suggests glial fibrillary acidic protein (GFAP) antibody, then GFAP IFA titer and GFAP CBA will be performed at an additional charge.
If N-methyl-D-aspartate (NMDA) receptor antibody CBA is positive, then NMDA-receptor antibody IFA titer assay will be performed at an additional charge.
If the IFA pattern suggests dipeptidyl-peptidase-like protein-6 (DPPX) antibody, then DPPX antibody CBA and DPPX IFA titer will be performed at an additional charge.
If the IFA pattern suggests metabotropic glutamate receptor 1 (mGluR1) antibody, then mGluR1 antibody CBA and mGluR1 IFA titer will be performed at an additional charge.
If the IFA pattern suggests neuronal intermediate filament (NIF) antibody, then alpha internexin CBA, NIF heavy chain CBA, NIF light chain CBA, and NIF IFA titer will be performed at an additional charge.
If the IFA pattern suggests neurochondrin antibody, then neurochondrin antibody CBA and neurochondrin IFA titer will be performed at an additional charge.
If the IFA pattern suggests septin-7 antibody, then septin-7 antibody CBA and septin-7 IFA titer will be performed at an additional charge.
If the IFA patterns suggest amphiphysin antibody, then amphiphysin IFA titer and amphiphysin immunoblot will be performed at an additional charge.
If the IFA pattern suggests antiglial nuclear antibody (AGNA-1), then AGNA-1 IFA titer and AGNA-1 immunoblot will be performed at an additional charge.
If the IFA pattern suggests antineuronal nuclear antibody type 1 (ANNA-1), then ANNA-1 IFA titer, ANNA-1 immunoblot, and ANNA-2 immunoblot will be performed at an additional charge.
If the IFA pattern suggests ANNA-2 antibody, then ANNA-2 IFA titer, ANNA-1 immunoblot, and ANNA-2 immunoblot will be performed at an additional charge.
If the IFA pattern suggests Purkinje cytoplasmic antibody type 1 (PCA-1), then PCA-1 IFA titer and PCA-1 immunoblot will be performed at an additional charge.
If the IFA pattern suggests PCA-2 antibody, then PCA-2 IFA titer will be performed at an additional charge.
If the IFA pattern suggests PCA-Tr antibody, then PCA-Tr IFA titer and PCA-Tr immunoblot will be performed at an additional charge.
If the IFA pattern suggests IgLON5 antibody, then IgLON5 IFA titer and IgLON5 cell-binding assay (CBA) will be performed at an additional charge.
If AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid) receptor antibody CBA is positive, then AMPA-receptor antibody IFA titer assay will be performed at an additional charge.
If gamma-aminobutyric acid B (GABA-B) receptor antibody CBA is positive, then GABA-B-receptor antibody IFA titer assay will be performed at an additional charge.
If the IFA pattern suggests glial fibrillary acidic protein (GFAP) antibody, then GFAP IFA titer and GFAP CBA will be performed at an additional charge.
If N-methyl-D-aspartate (NMDA) receptor antibody CBA is positive, then NMDA-receptor antibody IFA titer assay will be performed at an additional charge.
If the IFA pattern suggests dipeptidyl-peptidase-like protein-6 (DPPX) antibody, then DPPX antibody CBA and DPPX IFA titer will be performed at an additional charge.
If the IFA pattern suggests metabotropic glutamate receptor 1 (mGluR1) antibody, then mGluR1 antibody CBA and mGluR1 IFA titer will be performed at an additional charge.
If the IFA pattern suggests neuronal intermediate filament (NIF) antibody, then alpha internexin CBA, NIF heavy chain CBA, NIF light chain CBA, and NIF IFA titer will be performed at an additional charge.
If the IFA pattern suggests neurochondrin antibody, then neurochondrin antibody CBA and neurochondrin IFA titer will be performed at an additional charge.
If the IFA pattern suggests septin-7 antibody, then septin-7 antibody CBA and septin-7 IFA titer will be performed at an additional charge.
Preferred Specimen
4 mL CSF in a sterile container
Minimum Volume
2 mL
Transport Container
Plastic vial
Transport Temperature
Refrigerate
Specimen Stability
Refrigerated (preferred): 28 days
Frozen: 28 days
Ambient: 72 hours
Frozen: 28 days
Ambient: 72 hours
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Gross hemolysis: Reject
Gross lipemia: Reject
Gross icterus: Reject
Gross lipemia: Reject
Gross icterus: Reject
Methodology
GN1C, AGNTC, AMPIC, AMPHC, APHTC, ANN1C, AN1TC, ANN2C, AN2TC, ANN3C, AN3TC, CRMTC, CRMC, DPPIC, DPPTC, GABIC, GFAIC, GFATC, IG5IC, IG5TC, GL1IC, GL1TC, NCDIC, NCDTC, NIFIC, NIFTC, NMDIC, PCA1C, PC1TC, PCA2C, PC2TC, PCTRC, PCTTC, SP7IC, SP7TC: Indirect Immunofluorescence Assay (IFA) AMPCC, CS2CC, DPPCC, GABCC, GFACC, IG5CC, LG1CC, GL1CC, NCDCC, AINCC, NFLCC, NFHCC, NMDCC, SP7CC: Cell Binding Assay (CBA) CRMWC: Western Blot (WB) AGNBC, AMIBC, AN1BC, AN2BC, PC1BC, PCTBC: Immunoblot (IB) GD65C: Radioimmunoassay (RIA)
FDA Status
Approved
Setup Schedule
Profile tests: Monday through Sunday; Reflex tests: Varies
Report Available
8-12 days
Limitations
Negative results do not exclude autoimmune encephalopathy or cancer.
This test does not detect Ma1 or Ma2 antibodies (also known as MaTa), which are sometimes associated with brainstem and limbic encephalitis in the context of testicular germ cell neoplasms. Scrotal ultrasound is advised for men who present with unexplained subacute encephalitis.
This test does not detect Ma1 or Ma2 antibodies (also known as MaTa), which are sometimes associated with brainstem and limbic encephalitis in the context of testicular germ cell neoplasms. Scrotal ultrasound is advised for men who present with unexplained subacute encephalitis.
Reference Range
Included with report
Clinical Significance
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 using 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 or more pack-years) or other cancer risk factors
-Inflammatory cerebrospinal fluid (or isolated protein elevation)
-Neuroimaging signs suggesting inflammation
Evaluating limbic encephalitis (noninfectious)
Directing a focused search for cancer
Investigating encephalopathy appearing during or after cancer therapy and not explainable by metastasis or drug effect
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 or more pack-years) or other cancer risk factors
-Inflammatory cerebrospinal fluid (or isolated protein elevation)
-Neuroimaging signs suggesting inflammation
Evaluating limbic encephalitis (noninfectious)
Directing a focused search for cancer
Investigating encephalopathy appearing during or after cancer therapy and not explainable by metastasis or drug effect
Performing Laboratory
Mayo Clinic Laboratories, Rochester, Minnesota
Additional Information
Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
