{"id":15132,"date":"2020-09-23T14:49:00","date_gmt":"2020-09-23T18:49:00","guid":{"rendered":"https:\/\/www.shortform.com\/blog\/?p=15132"},"modified":"2020-10-01T13:57:23","modified_gmt":"2020-10-01T17:57:23","slug":"brain-on-fire-diagnosis","status":"publish","type":"post","link":"https:\/\/www.shortform.com\/blog\/brain-on-fire-diagnosis\/","title":{"rendered":"Brain on Fire Diagnosis Took Many Tests + Brain Biopsy"},"content":{"rendered":"\n

How did doctors finally reach a diagnosis in Brain on Fire<\/em>? What was the Brain on Fire <\/em>diagnosis?<\/p>\n\n\n\n

The Brain on Fir<\/em>e diagnosis was anti-NMDA-receptor encephalitis. After many tests, including a brain biopsy, doctors were able to give Susannah Cahalan an answer.<\/p>\n\n\n\n

Read more about the Brain on Fire<\/em> diagnosis and how doctors got there.<\/p>\n\n\n\n\n\n\n\n

Challenges Reaching a Brain on Fire Diagnosis<\/h2>\n\n\n\n

Susannah\u2019s second spinal tap showed an increased white blood cell count, from 20 to 80. The doctors start looking for a source of infection in Susannah\u2019s brain. <\/p>\n\n\n\n

Dr. Najjar<\/a> has a flash of insight: what if Susannah\u2019s inflammation is the result of an autoimmune reaction? What if her own immune system is attacking her brain? <\/strong>He recalls a paper written by a Dr. Dalmau<\/a> at the University of Pennsylvania, describing four young women stricken by a rare autoimmune disease<\/a>. Could Susannah have the same “brain on fire” diagnosis?<\/p>\n\n\n\n

Dr. Najjar has other questions, too, before being able to diagnose brain on fire. How much inflammation is there? Can her brain be saved? <\/p>\n\n\n\n

He knows he can only answer these questions by removing a tiny portion of her brain for study, but he doesn\u2019t know if Susannah\u2019s parents will agree to such a drastic procedure.<\/p>\n\n\n\n

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.<\/p>\n\n\n\n

\u201cHer brain is on fire,\u201d he announces to Susannah\u2019s parents. Then he turns to her and says, \u201cI will do everything I can for you.\u201d In the hallway, he tells them that the best way to treat her is to do a brain biopsy and confirm the Brain on Fire<\/em> diagnosis. \u201cI would do it if it were my child,\u201d he gently cautions.<\/p>\n\n\n\n

Two days before the surgery, the head nurse comes to Susannah\u2019s room to describe what\u2019s 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.<\/strong> \u201cWhat\u2019s the slope of the line?\u201d he asks. Susannah can\u2019t remember. \u201cPositive,\u201d her dad urges. Susannah angles her arm upwards, as her dad had done the first time. \u201cGetting better every day,\u201d he smiles. <\/p>\n\n\n\n

On Monday morning, Susannah is wheeled into surgery. She doesn\u2019t 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, \u201cWhat is the slope of the line?\u201d This time she responds: \u201cPositive.\u201d<\/p>\n\n\n\n

Understanding Brain Biopsies<\/h3>\n\n\n\n

Brain biopsies are relatively simple compared to other forms of brain surgery, but they involve dangerous risks, such as infection or mistakes.<\/p>\n\n\n\n

Susannah\u2019s biopsy involved a process called frameless stereotactic neurosurgery. It visually maps the brain in two and three dimensions, enabling the surgeon to accurately target a specific region of the brain\u2014in Susannah\u2019s case, the right frontal cortex.<\/p>\n\n\n\n

First the surgeon made an incision in Susannah\u2019s scalp. He parted the skin and used a high-speed drill to create a 1-centimeter hole in the skull. He then used a bigger drill to grind the bone into dust to remove a 3-centimeter piece of bone plate. <\/p>\n\n\n\n

This exposed the protective layer of Susannah\u2019s brain. The surgeon removed a section, then removed 1 cubic centimeter of brain tissue, including white and gray matter. <\/p>\n\n\n\n

With the tissue removed, the surgeon stopped the blood flow, stitched a graft onto the brain\u2019s outer layer, sutured it, and reattached the piece of bone plate with screws and a metal plate. He finished by replacing the outer layer of skin in its original position and closing the scalp with staples.<\/p>\n\n\n\n

The surgery lasted four hours. <\/p>\n\n\n\n

The biopsy confirms that Susannah\u2019s brain is inflamed, seemingly under attack by her own immune system. She\u2019s put on the highest possible dose of intravenous steroids, but her condition doesn\u2019t improve right away. Her panic attacks increase, accompanied by grimacing, shaking, and zombie-like arm motions, finally leading toward the Brain on Fire<\/em> diagnosis. <\/p>\n\n\n\n

Dr. Najjar believes Susannah has autoimmune encephalitis, which is close to the eventual Brain on Fire <\/em>diagnosis. Dr. Russo thinks she has paraneoplastic syndrome, a condition associated with cancer: As the immune system attacks the cancer, it may also attack healthy tissue in the spine or brain, causing psychosis or catatonia.<\/p>\n","protected":false},"excerpt":{"rendered":"

How did doctors finally reach a diagnosis in Brain on Fire? What was the Brain on Fire diagnosis? The Brain on Fire diagnosis was anti-NMDA-receptor encephalitis. After many tests, including a brain biopsy, doctors were able to give Susannah Cahalan an answer. Read more about the Brain on Fire diagnosis and how doctors got there.<\/p>\n","protected":false},"author":6,"featured_media":15287,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[16,9],"tags":[130],"class_list":["post-15132","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health","category-psychology","tag-brain-on-fire","","tg-column-two"],"yoast_head":"\nBrain on Fire Diagnosis Took Many Tests + Brain Biopsy - Shortform Books<\/title>\n<meta name=\"description\" content=\"What was the Brain on Fire diagnosis? 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