Patient Narrative: Anti-NMDA Receptor Encephalitis

tt04 dockedStill working on a follow-up post on brain death. For now, I wanted to pass along a book recommendation pertinent to today’s excellent morning report. It’s Brain on Fire: My Month of Madness, by Susannah Cahalan. Ms. Cahalan is actually a journalist, and she provides a superb narrative of her experience with anti-NMDA receptor encephalitis back when the entity wasn’t very well-known.

In addition to a fantastic account of her saga, the book contains many lessons for our neurologic practices. One theme that kept standing out to me was that the diagnosis was delayed in some measure because the neurological method (i.e., putting some thought into how to frame the case, then proceeding to localize, then considering the etiologic differential diagnosis) wasn’t being followed. For example: Ms. Cahalan was a young, previously healthy, highly-educated, and high-functioning woman with strong social support. Yes, she partied with alcohol, but to just pat her on the knee and tell her that her EEG was normal so she just needed to cut back on her drinking exemplifies the cognitive error of premature closure.

There are also some lessons regarding interpersonal communication. For example: After the diagnosis was finally made, a resident took a team on bedside teaching rounds and casually remarked, “No teratoma was found, but we may just remove her ovaries anyway”, an intervention never before discussed with the patient or her family.

This book is a real page-turner; poignant, insightful, and often cringe-inducing. I highly recommend it.

About Justin A. Sattin

I'm a vascular neurologist and residency program director. I created this blog in order to share some thoughts with my resident and other colleagues, and to foster my own learning as well.
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