- Serum glucose, electrolytes, calcium/phosphorus, uric acid, lactate and pyruvate, liver, renal and thyroid function tests, blood gasses
- Prolactin levels (10 to 20 min after suspected seizure, diagnosis seizure vs. psychogenic nonepileptic seizure)
- Serum CK
- ANA, ENA, ANCA, RF, complement, ACE, anti-thyroglobulin and anti-thyroperoxidase antibodies (Hashimoto disease), autoantibody panel (thyroid antimicrosomal, antiparietal), immunoglobulins
- Serum ceruloplasmin and copper, 24h urinary copper, slit lamp, liver biopsy (WD)
- CBC, ESR, CRP, plasma fibrinogen
- Coagulation profile (protein C and S, ATIII, Factor Leiden V, APLS, anticardiolipin)
- Serum vitamin B12 and folic acid
- RPR, TPHA
- Serum cortisol, PTH and osmolality.
- Serology: HIV, HSV, adenovirus, CMV, Coxsackie, polio, echovirus, hepatitis (A,B,C), parvovirus B19, mycoplasma, toxoplasma, VDRL, cysticercosis
- Blood and urine organic acids and carnitine
- Chest X-ray
- EEG (non-convulsive status epilepticus), VEP, EMG/NCVs
- Brain MRI, MRA
- Conventional angiogram (CNS vasculitis)
- serum ammonium
- Besides routine analysis (chemistry, cell count, smear and stainings): lactate and pyruvate (mitochondrial disease), oligoclonal bands, IgG index, VDRL, viral (measles titer), fungal, PCR (T. Whippleii, JC virus, HSV, CMV, VZV), Ziehl staining, repeated cytology,
- anti-thyroglobulin and anti-thyroperoxidase antibodies (Hashimoto disease).
- 14-3-3 protein (CJD) (stable at room temperature and can be sent by regular mail)
- Aminolevulinic acid, porphobilinogen, uroporphyrins, coproporphyrin
- Antineural nuclear antibodies (ANNA-1(=Anti-Hu), ANNA-2 (=anti-Ri), ANNA-3, Purkinje cell cytoplasmic antibodies (PCCA-1 (=anti-Yo), PCCA-2, PCCA-Tr and mGluR1), plasma membrane cation channel antibodies (CV2/CRMP-5, Ma1, Ma2/Ta, amphiphysin, striational, voltage gated calcium channels (VGCC) and voltage gated potassium channels (VGKC), anti-NMDA-R (NR1 and NR2) antibodies.
- Methylmalonic acid, VLCFA, arylsulphatase, homocysteine
- Conjunctiva (sarcoidosis),
- Small bowel (Whipple disease)
- Skin (SLE, vasculitis, CADASIL)
- Brain biopsy
COMA Algorithm (ENLS 2017)
Neurologic Etiologies of Coma
Toxic-Metabolic Etiologies of Coma
“Acute Encephalopathy Work-Up.” Neuroweb.us. http://www.neuroweb.us/Chapters/acute%20encephalopathy/work_up.htm, 2017. Web. 18 Aug. 2017.