Below is a summary in chronological order (as best I can remember) of 3 weeks of in-patient investigations at the National Hospital for Neurology and Neurosurgery in August/September 2011. I'll describe the progression of diagnoses later. Note that most of these tests were either looking for non-CLIPPERS conditions or were to exclude non-CLIPPERS conditions. Some tests were prompted by findings peculiar to me in other investigations so may not form part of the standard work-up. For comparison I also list the other major investigations reported in the literature for patients being investigated for CLIPPERS. I'm sure there was also lots of variation in the blood and cerebral-spinal fluid tests which I don't have knowledge of. As Sherlock Holmes said:
My Investigations
- Bedside neurological work-up (many times, many Drs).
- Blood tests (26 various)
- Urine samples (4 various)
- Brain MRI (with contrast)
- Peripheral nerve conduction
- Spinal MRI (with contrast)
- Lumbar puncture (2 successful under x-ray guidance) (oligoclonal bands and flow cytometry)
- CT angiography (brain)
- Tuberculosis test
- Orthoptics assessment
- Fundus microscopy
- Visual and auditory evoked potentials.
- Electrocardiogram
- PET head and chest.
- 24 hour urine collection (protein)
- 24 hour urine collection (calcium)
- CT (chest)
- Kidney ultrasound
- Cardiac ultrasound
- Brain biopsy (declined - I will return to this topic at some length later)
- Repeat brain MRI (with contrast) (post-treatment)
Other Patient's Reported Investigations
- Brain biopsy
- Conjunctival biopsy
- CT (abdomen and pelvis)
- Magnetic Resonance Angiography
- Mammogram
- Somatosensory evoked potentials
- Testicular ultrasound
- Transbronchial lung biopsy
The investigations reported on other patients clearly reflect the difficulty in diagnosing CLIPPERS and the variety of possible causes considered for individual cases.
Read other articles in this series at Living With CLIPPERS.
Living With CLIPPERS by Bill Crum is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
