Dr. Dalmau: The Expert on the Brain on Fire Disease

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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Who is Dr. Dalmau? How did he establish himself as an expert in anti-NMDA-receptor encephalitis?

Dr. Dalmau is the neuro-oncologist that wrote about a rare autoimmune disease. Susannah Cahalan’s symptoms were similar and her doctor consulted with him.

Read more about the discoveries made by Dr. Dalmau and how he helped Susannah.

Who Was Dr. Dalmau?

Dr. Najjar 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?

Drs. Russo and Najjar send Susannah’s cerebrospinal fluid to Dr. Dalmau, the neuro-oncologist who had conducted the study on four young women that Dr. Najjar remembered when he saw Susannah’s clock test. Like Susannah, the four women in the study had a high white blood cell count and suffered from hallucinations, confusion, and memory deficits. They also had two other things in common: an ovarian tumor and antibodies that disable a critical apparatus in the brain called the NMDA receptor. By the time Susannah is struck by the disease, Dr. Dalmau has developed two tests that allow for a swift and accurate diagnosis. 

Medical Aside

Everything we do, from lifting a glass to reading a book, results from a chemical signal triggering specific brain cells to fire or not. If a cell can’t receive a signal, it can’t initiate or inhibit behavior.

Cells receive signals through receptors. NMDA receptors excite cells that participate in learning, memory, higher functions, and personality. In 2007, Dr. Dalmau identified a new disease that would come to be called anti-NMDA-receptor encephalitis. This condition is caused when antibodies disable NMDA receptors. Experiments indicate that a 40 percent loss of NMDA receptors results in psychosis. A 70 percent loss results in catatonia. An absence of any working NMDA receptors results in death.

Receiving Results From Dr. Dalmau

While they’re waiting for the results of Dalmau’s tests, Susannah’s team decides to assess Susannah’s cognitive skills. They’ll use the assessment as a baseline for judging future progress. 

That afternoon Dr. Russo gives Susannah’s dad the news they’ve been waiting for: Dr. Dalmau has confirmed a diagnosis of anti-NMDA-receptor encephalitis.

Dr. Dalmau: The Expert on the Brain on Fire Disease

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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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