Mumbai: Woman with ‘brain on fire’ for 6 months treated at KEM Hospital – Times of India

MUMBAI: For six months, Kalbadevi resident Dimple Choksi wasn’t herself. She would speak gibberish, laugh inappropriately, keep rotating in an anti-clockwise manner instead of walking straight and had pulled out most of the hair from her crown.

It was almost an overnight transformation, recalled husband Amit. “She woke up one morning in August 2021 complaining of a severe headache, and over the next few days, she changed,” he said. The 45-year-old’s memory was so impaired that she didn’t remember how to brush her teeth.
The family visited 10 doctors, including psychiatrists, neurologists and homeopaths, in Mumbai and Ahmedabad between August and January and got various diagnoses, including psychosis and schizophrenia. Dimple was put on 15 tablets, including six psychiatric drugs, a day.
It was February by the time the Choksis got a rare but terrifying diagnosis-seronegative autoimmune encephalitis-at BMC-run KEM Hospital, Parel. Since then, her symptoms have vanished. “But I don’t recollect anything from the six months,” she told TOI.
Her case was among the unusual cases discussed at KEM’s monthly staff society meetings, a tradition that was revived on Friday after being on hold during the pandemic. Titled ‘Decoding a psychiatry puzzle, the neurology way’, neurologist Dr Parthvi Ravat highlighted how Dimple’s illness was diagnosed using a PET scan that is commonly used to detect cancer cells. “After observing her and listening to the family, we suspected autoimmune encephalitis,” said Dr Parthvi Ravat. But the diagnosis was difficult. A decade ago, New York Post reporter Susannah Cahalan wrote a book on suffering from autoimmune encephalitis.
Seronegative autoimmune encephalitis falls in a grey zone between psychiatry and neurology. “Neurologists would overdiagnose it while psychiatrists believe it is psychosis or schizophrenia that could be treated with medication and shock therapy,” said psychiatrist Dr Harish Shetty.
The KEM team first ruled out infections caused by viruses, bacteria or fungi. Then an MRI scan was conducted and her cereberospinal fluid sent to NIMHANS, Bengaluru, for antibody testing to confirm their suspicion. “But the scan was normal and her samples were negative for antibodies,” said the doctor. A PET scan was then done which showed high activity in the brain’s frontal lobes, the largest lobes that are the seat of voluntary movement, memory, attention, speech, controlling impulses and social behaviour. “Based on the clinical judgement, the PET scan and diagnostic criteria laid down, we then decided she had sero-negative autoimmune encephalitis,” said Dr Parthvi Ravat.
The diagnosis was further confirmed when she responded to the treatment: A dose of steroids and five-day course of intravenous immunoglobulin (IVIg) to reduce inflammatory conditions in the body. A PET scan repeated on Friday showed highly reduced activity in the frontal lobe.
“In cases of sudden, short-duration psychiatric symptoms, brain disorder or an organic cause shouldn’t be ruled out,” said KEM Hospital dean Dr Sangeeta Ravat, who also heads neurology department. “Doctors have to rely on clinical acumen and use ancillary investigations to come to a diagnosis,” she said. “We want people to know it’s not always madness, but a neurological problem,” said Amit Choksi.