History and examination |
MRI of the spine |
MRI of the brain if bulbar involvement |
Cerebrospinal fluid analysis |
- Cell count and differential
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- Viral PCRs (nonpolio enteroviruses, flaviviruses)
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- Flavivirus antibody testing (West Nile virus, Zika virus)
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Blood testing |
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- Autoimmune serology for vasculitis
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- West Nile virus IgM antibody
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- Zika and dengue serology if indicated
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Stool samples for polio and nonpolio enteroviruses |
Nasopharyngeal swabs for nonpolio enteroviruses |
Respiratory tract culture and toxin testing for diphtheria |
Toxin testing in serum, stool, and wounds for botulism |
Urinary porphobilinogen for porphyria |
Acetylcholine receptor antibodies for myasthenia gravis |
Electrodiagnostic testing (electromyography, nerve conduction studies, and repetitive stimulation studies) |
Nerve and muscle biopsy if vasculitis suspected |