Neuro Note 1: Brain on Fire by Susannah Cahalan

     When scanning the extensive list of resources for writing our Neuro Notes, I saw that Brain on Fire by Susannah Cahalan was included on this list. I was thrilled to find it mentioned seeing as it is one of my favorite books. Cahalan's personal reflection on what she called her lost month of madness provides us with a narrative that is extremely readable, powerful, and one that has storyline so unfathomable, it seems as if it should be non-fiction.

     Cahalan provides readers with a firsthand account of her experience with Anti-NMDA receptor encephalitis, a type of autoimmune encephalitis. When she first experienced symptoms, she was a successful 24 year old reporter living in New York City. Her symptoms began out of the blue with her seeing what she thought to be bug bites, but more severe symptoms rapidly began to affect Susannah. Psychotic episodes, paranoia, catatonia, seizures, and hallucinations eventually led to her admittance to NYU's Langone Hospital where she was misdiagnosed with several diagnoses including mononucleosis and schizoaffective disorder. After many inconclusive tests and interacting with a number of baffled doctors, Dr. Souhel Najjar was able to uncover the evidence necessary to correctly diagnose Susannah. Dr. Najjar had her draw a clock face, a test that is more commonly used with dementia patients. When Susannah drew her clock, she drew all of the numbers 1 through 12 on the right side of the clock and left the left side of the clock blank. This showed that she was having left side spatial neglect, thus signaling inflammation on the right side of her brain. This piece of evidence was what kickstarted Dr. Najjar's being able to diagnosis Susannah with Anti-NMDA receptor encephalitis, a disease in which the antibodies produced by one's immune system attack the NMDA receptors in the brain.  

     The novel goes on to talk about the period of time after her recovery and speaks about the number of misdiagnosed cases of Anti-NMDA receptor encephalitis. Cahalan's experience has increased awareness of her diagnosis and has proved positive implications for many people in situations similar to Susannah's. The creation of the novel itself is fascinating seeing as she has no memory of her month long stay at the hospital. Cahalan used her journalistic skills to write this novel by compiling information from her own medical records, family journals, hospital surveillance, and interviews conducted with physicians, family, and friends.

     From this novel, there are many ties to our course. One example is seen with Susannah's experience of left neglect. Because she was unaware of things on her left side, this pointed to a problem on the right side of her brain. There are other examples of how the swelling that was occurring in her brain, especially in the frontal lobe where there is a high concentration of NMDA receptors, affected things such as her personality, memory, and voluntary movements. I learned a lot about the science behind what was happening in Cahalan's brain, but I also learned a lot about the thought process behind living with this disease and the emotional turmoil that comes with being misdiagnosed or undiagnosed. This novel goes to show how powerful a well-told story can be, and I would certainly recommend this novel as a fascinating insight into the life of a person with a neurological autoimmune disease. 

Cahalan, S. (2012). Brain on fire: my month of madness. New York: Free Press.