XXXX : a 10-year prospective study on the value of diagnostic tests.

@entity1 @entity146 @entity1333 @entity2286 @entity1252 @entity432 @entity12319
PURPOSE: To evaluate which serologic, cerebrospinal fluid (CSF), and neuroradiographic tests alone or in combination are most useful in the diagnosis of @entity12319 ( @entity12319 ). @entity1 AND METHODS: Prospective study of @entity1 with @entity1252 ( @entity1252 ) hospitalized with @entity146 between January 1982 and December 1991. Special tests evaluated as part of this study included serum antinuclear antibodies, complement levels, serum and CSF antineuronal antibodies, CSF special protein studies (immunoglobulin G [IgG] index and oligoclonal bands), serum antiribosomal-P antibodies, serum antiphospholipid antibodies, and cranial magnetic resonance imaging (MRI). Diagnostic sensitivity, specificity, and positive predictive value ( @entity2286 ) were determined for single tests and combinations of tests. RESULTS: Fifty-two @entity12319 @entity1 were categorized by neuropsychiatric presentation (32 diffuse, 10 focal, and 10 complex presentations) and compared to 14 @entity1252 control @entity1 . Each @entity12319 @entity1 with a diffuse or complex presentation had abnormal CSF IgG index/oligoclonal bands, elevated CSF antineuronal antibodies, and/or serum antiribosomal-P antibodies, yielding a sensitivity of 100%, specificity of 86%, and @entity2286 of 95% for this combination of tests. Nine of 10 @entity1 with focal presentations and all with complex disease had evidence of @entity1333 , antiphospholipid antibodies, and/or a cranial MRI with multiple lesions, giving a sensitivity of 95%, specificity of 86%, and a @entity2286 of 90% for this battery of tests. These combinations of tests correctly diagnosed all nine @entity1252 @entity1 whose initial diagnosis proved to be incorrect based on subsequent clinical course. Abnormal test results frequently normalized or improved with successful therapy. CONCLUSIONS: Specific tests for CSF antibodies are most useful diagnostically in diffuse @entity12319 , implicating autoantibodies in the pathogenesis of this @entity12319 presentation. In those @entity1 with diffuse @entity12319 who present with primarily @entity146 , serum antiribosomal-P antibodies appear to be helpful. In contrast, focal @entity12319 appears to be mostly secondary to @entity432 , and the presence of @entity1333 , antiphospholipid antibodies, and/or an abnormal cranial MRI are most helpful diagnostically. @entity1 with complex presentations demonstrate abnormalities characteristic of both diffuse and focal @entity12319 . Abnormal tests can be followed serially and appear to correlate with clinical responses to therapy.
