Autoimmune Inflammation: If Your Body Turns on You

This article is an excerpt from the Shortform summary of "Brain On Fire" by Susannah Cahalan. Shortform has the world's best summaries of books you should be reading.

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What is autoimmune inflammation? Is it related to an inflammatory immune system response? What is the relationship between inflammation and the immune system?

Autoimmune inflammation is an inflammatory immune system response directed at one’s own body. In Brain on Fire, the autoimmune inflammation was attacking the brain.

Read more about autoimmune inflammation, including the relationship between inflammation and the immune system.

Was Autoimmune Inflammation the Culprit?

Dr. Najjar has a flash of insight: what if Susannah’s inflammation is the result of an autoimmune reaction? What if her own immune system is attacking her brain? He recalls a paper written by a Dr. Dalmau at the University of Pennsylvania, describing four young women stricken by a rare autoimmune disease. Could Susannah have the same condition?

Dr. Najjar has other questions, too. How much autoimmune inflammation is there? Can her brain be saved? 

He knows he can only answer these questions by removing a tiny portion of her brain for study, but he doesn’t know if Susannah’s parents will agree to such a drastic procedure.

The longer Susannah goes without intervention, the smaller her chances of recovering. Recognizing the gravity of the moment, Najjar paces around the room before sitting on the bed next to Susannah.

“Her brain is on fire,” he announces to Susannah’s parents. Then he turns to her and says, “I will do everything I can for you.” 

Susannah comes alive. She sits up and throws her arms around Dr. Najjar, tears gathering in the corner of her eyes. Sensing the real Susannah is still in there somewhere, he motions to her parents to follow him out of the room. In the hallway, he tells them that the best way to treat her is to do a brain biopsy. “I would do it if it were my child,” he gently cautions.

They’re overwhelmed by the news. Separately and together, they sob. They pray. Eventually, after much terrified soul-searching, they consent to the operation.

The Brain Biopsy

Two days before the surgery, the head nurse comes to Susannah’s room to describe what’s about to happen. Susannah listens calmly, but she and her dad break into tears that evening. As they laugh and cry together, he brings up the family motto. “What’s the slope of the line?” he asks. Susannah can’t remember. “Positive,” her dad urges. Susannah angles her arm upwards, as her dad had done the first time. “Getting better every day,” he smiles. 

On Monday morning, Susannah is wheeled into surgery. She doesn’t react when a resident shaves her head. Interpreting this as a sign of strength, her dad kneels by the side of her bed, tears in his eyes, and asks once again, “What is the slope of the line?” This time she responds: “Positive.”

The biopsy confirms that Susannah’s brain is inflamed, seemingly under attack by her own immune system.

Autoimmune Inflammation: If Your Body Turns on You

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Like what you just read? Read the rest of the world's best summary of Susannah Cahalan's "Brain On Fire" at Shortform.

Here's what you'll find in our full Brain On Fire summary:

  • How a high-functioning reporter became virtually disabled within a matter of weeks
  • How the author Cahalan recovered through a lengthy process and pieced together what happened to her
  • How Cahalan's sickness reveals the many failures of the US healthcare system

Rina Shah

An avid reader for as long as she can remember, Rina’s love for books began with The Boxcar Children. Her penchant for always having a book nearby has never faded, though her reading tastes have since evolved. Rina reads around 100 books every year, with a fairly even split between fiction and non-fiction. Her favorite genres are memoirs, public health, and locked room mysteries. As an attorney, Rina can’t help analyzing and deconstructing arguments in any book she reads.

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