Limbic encephalitis was causing the trouble - The doctor and
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Gautam Varma
Limbic encephalitis was causing the trouble - The doctor and the teenager
Doctors believed that Mia had limbic encephalitis, an inflammation of the brain; the disease can be triggered by an infection or an autoimmune reaction in which the body attacks itself. A spinal tap and other tests confirmed Mia’s encephalitis diagnosis, but scans did not find cancer or an ovarian tumor. Mia was immediately started on high-dose steroids and other medications, augmented by a cocktail of psychiatric drugs to diminish the hallucinations and other symptoms. But instead of getting better, Mia continued to deteriorate. After a week, it was clear that first-line treatment was failing. There was little choice except to try the other remaining treatment: infusions of a potent anti-cancer medicine called Rituxan. A few days after the first dose, Mia became less agitated, and her speech was less odd. Luckily, she shows no signs of residual cognitive or motor impairment. The cause of her encephalitis remains unidentified, because doctors have not found a tumor or other trigger. Mia will be closely monitored for several years, Marcuse said, because the disease sometimes recurs.

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Mia began screaming “out of nowhere” and complained that her mouth was “distorted.” Mia calmed down quickly and, with the help of a Valium, went to sleep. The next morning, Mia said she felt fine and brushed off questions about what had been wrong. But the following day her mother Carmen received a frantic call at her office from Mia, who yelled “Mom, help me!” but refused to elaborate. She raced home to discover that Mia was too afraid to leave their apartment and go to the therapist by herself, something she’d done dozens of times. They went together, and by the time they arrived Mia seemed herself, if somewhat anxious. The next few days were punctuated by bizarre episodes. She complained that one of her arms was longer than the other, and she stood in an oddly hunched posture to compensate. Sounds seemed excessively loud and colors looked so bright they were painful, she recalled. Mia called her uncle “Dad” and started speaking as though her mouth was full of cotton. The therapist agreed that Mia should be watched closely. Can you find out what was causing trouble ?

Clue 1 : A toxicology screen for drugs was negative, as were tests for pregnancy, Lyme disease and HIV.

Clue 2: An MRI scan of her brain was clear, which ruled out a brain tumor.

Clue 3: The diagnosis was atypical psychosis, and Mia was started on high doses of antipsychotic drugs.

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