"""
Autoimmune Encephalitis - Comprehensive Neurology Seminar PPT
MD Medicine Resident Presentation
"""

from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.util import Inches, Pt
import json, subprocess, base64
from io import BytesIO

# ── Color Palette ────────────────────────────────────────────────
DARK_NAVY    = RGBColor(0x0D, 0x1B, 0x2A)   # deep navy for title bars
MED_BLUE     = RGBColor(0x1A, 0x6F, 0xAA)   # medium blue accents
LIGHT_BLUE   = RGBColor(0xE8, 0xF4, 0xFD)   # soft background
TEAL         = RGBColor(0x00, 0x8B, 0x8B)   # teal for highlights
ACCENT_RED   = RGBColor(0xC0, 0x39, 0x2B)   # red for alerts/warnings
WHITE        = RGBColor(0xFF, 0xFF, 0xFF)
LIGHT_GRAY   = RGBColor(0xF5, 0xF5, 0xF5)
DARK_GRAY    = RGBColor(0x2C, 0x3E, 0x50)
GOLD         = RGBColor(0xF3, 0x9C, 0x12)
GREEN        = RGBColor(0x1E, 0x8B, 0x4C)

# ── Helpers ──────────────────────────────────────────────────────
def add_rect(slide, left, top, width, height, fill_color, alpha=None):
    shape = slide.shapes.add_shape(
        1,  # MSO_SHAPE_TYPE.RECTANGLE
        Inches(left), Inches(top), Inches(width), Inches(height)
    )
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_color
    shape.line.fill.background()
    return shape

def add_textbox(slide, left, top, width, height, text, font_size=18,
                bold=False, color=DARK_GRAY, align=PP_ALIGN.LEFT,
                italic=False, wrap=True, font_name="Calibri"):
    tb = slide.shapes.add_textbox(
        Inches(left), Inches(top), Inches(width), Inches(height)
    )
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.margin_left = Pt(4)
    tf.margin_right = Pt(4)
    tf.margin_top = Pt(2)
    tf.margin_bottom = Pt(2)
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.size = Pt(font_size)
    run.font.bold = bold
    run.font.italic = italic
    run.font.color.rgb = color
    run.font.name = font_name
    return tb

def add_multiline_textbox(slide, left, top, width, height, lines,
                           font_size=14, color=DARK_GRAY, bold=False,
                           line_spacing_pt=None, font_name="Calibri",
                           bullet_char="•"):
    """lines = list of (text, bold, color, size) tuples or plain strings"""
    tb = slide.shapes.add_textbox(
        Inches(left), Inches(top), Inches(width), Inches(height)
    )
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = Pt(4)
    tf.margin_right = Pt(4)
    tf.margin_top = Pt(2)
    tf.margin_bottom = Pt(2)

    for i, line in enumerate(lines):
        if isinstance(line, str):
            txt, b, c, sz = line, bold, color, font_size
        else:
            txt = line[0]
            b   = line[1] if len(line) > 1 else bold
            c   = line[2] if len(line) > 2 else color
            sz  = line[3] if len(line) > 3 else font_size

        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        p.alignment = PP_ALIGN.LEFT
        run = p.add_run()
        run.text = txt
        run.font.size = Pt(sz)
        run.font.bold = b
        run.font.color.rgb = c
        run.font.name = font_name
        if line_spacing_pt:
            from pptx.oxml.ns import qn
            from lxml import etree
            pPr = p._pPr if p._pPr is not None else p._p.get_or_add_pPr()
            lnSpc = etree.SubElement(pPr, qn('a:lnSpc'))
            spcPts = etree.SubElement(lnSpc, qn('a:spcPts'))
            spcPts.set('val', str(int(line_spacing_pt * 100)))
    return tb

def title_slide_header(slide, title_text, subtitle_text=""):
    """Full-bleed dark navy header for title slide"""
    add_rect(slide, 0, 0, 13.333, 7.5, DARK_NAVY)
    # decorative accent bar
    add_rect(slide, 0, 5.8, 13.333, 0.12, TEAL)
    add_rect(slide, 0, 5.92, 13.333, 0.12, GOLD)

def section_header(slide, title, subtitle="", icon=""):
    """Slide with colored top bar"""
    add_rect(slide, 0, 0, 13.333, 1.35, DARK_NAVY)
    add_rect(slide, 0, 1.35, 13.333, 0.07, TEAL)
    add_textbox(slide, 0.35, 0.18, 12.5, 1.0, title,
                font_size=28, bold=True, color=WHITE,
                align=PP_ALIGN.LEFT, font_name="Calibri")
    if subtitle:
        add_textbox(slide, 0.35, 0.85, 12.0, 0.5, subtitle,
                    font_size=14, bold=False, color=RGBColor(0xA8, 0xD8, 0xEA),
                    align=PP_ALIGN.LEFT)

def footer(slide, text="Autoimmune Encephalitis | MD Medicine Neurology Seminar"):
    add_rect(slide, 0, 7.15, 13.333, 0.35, DARK_NAVY)
    add_textbox(slide, 0.3, 7.17, 12.5, 0.28, text,
                font_size=9, color=RGBColor(0xB0, 0xC4, 0xDE),
                align=PP_ALIGN.LEFT)

def colored_box(slide, left, top, width, height, fill, text, text_size=13,
                text_color=WHITE, bold=False):
    add_rect(slide, left, top, width, height, fill)
    add_textbox(slide, left+0.08, top+0.05, width-0.16, height-0.1,
                text, font_size=text_size, color=text_color, bold=bold, wrap=True)

# ── Create Presentation ──────────────────────────────────────────
prs = Presentation()
prs.slide_width  = Inches(13.333)
prs.slide_height = Inches(7.5)
blank = prs.slide_layouts[6]

# ═══════════════════════════════════════════════════════════════
# SLIDE 1 – TITLE SLIDE
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, DARK_NAVY)
add_rect(slide, 0, 5.9, 13.333, 0.15, TEAL)
add_rect(slide, 0, 6.05, 13.333, 0.15, GOLD)

# Brain icon placeholder (decorative circle)
add_rect(slide, 9.8, 0.8, 2.8, 2.8, MED_BLUE)
add_textbox(slide, 9.8, 0.8, 2.8, 2.8, "🧠",
            font_size=80, align=PP_ALIGN.CENTER, color=WHITE)

add_textbox(slide, 0.6, 0.5, 8.8, 0.6,
            "MD MEDICINE NEUROLOGY SEMINAR",
            font_size=14, bold=False, color=TEAL, font_name="Calibri")

add_textbox(slide, 0.6, 1.15, 8.8, 2.0,
            "AUTOIMMUNE\nENCEPHALITIS",
            font_size=52, bold=True, color=WHITE,
            align=PP_ALIGN.LEFT, font_name="Calibri")

add_textbox(slide, 0.6, 3.3, 8.8, 0.55,
            "Pathophysiology • Diagnosis • Management",
            font_size=20, bold=False,
            color=RGBColor(0xA8, 0xD8, 0xEA), font_name="Calibri")

add_textbox(slide, 0.6, 4.0, 8.8, 0.45,
            "Based on: Adams & Victor's Neurology 12e | Harrison's 22e | Goldman-Cecil Medicine | Washington Manual",
            font_size=11, color=RGBColor(0x7F, 0x9F, 0xBF))

add_textbox(slide, 0.6, 5.3, 8.8, 0.4,
            "Presented by: MD Medicine Resident  |  Department of Neurology",
            font_size=13, color=RGBColor(0xCC, 0xDD, 0xEE))


# ═══════════════════════════════════════════════════════════════
# SLIDE 2 – OVERVIEW / TABLE OF CONTENTS
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Overview", "What we will cover today")

topics = [
    ("1", "Introduction & Historical Perspective"),
    ("2", "Epidemiology & Incidence"),
    ("3", "Classification of Autoimmune Encephalitis"),
    ("4", "Pathophysiology & Mechanisms"),
    ("5", "Anti-NMDA Receptor Encephalitis (NMDAR-E)"),
    ("6", "Other Antibody Syndromes: LGI1, CASPR2, AMPAR, GABA"),
    ("7", "Paraneoplastic vs. Non-Paraneoplastic AE"),
    ("8", "Clinical Presentation & Phases"),
    ("9", "APE2 Score – Predicting Antibody Positivity"),
    ("10", "Investigations – MRI, EEG, CSF"),
    ("11", "Antibody Testing Strategy"),
    ("12", "Diagnostic Criteria (Graus 2016)"),
    ("13", "Differential Diagnosis"),
    ("14", "Immunotherapy – First Line"),
    ("15", "Immunotherapy – Second & Third Line"),
    ("16", "Tumor Search & Oncologic Treatment"),
    ("17", "Monitoring, Relapse & Long-term Follow-up"),
    ("18", "Special Populations: Pediatric & Pregnancy"),
    ("19", "Checkpoint Inhibitor-Related AE"),
    ("20", "Prognosis & mRS"),
    ("21", "Case Vignette"),
    ("22", "Key Takeaways & References"),
]

col_lines_left  = topics[:11]
col_lines_right = topics[11:]

def toc_lines(items):
    result = []
    for num, text in items:
        result.append((f"  {num}.  {text}", False, DARK_GRAY, 12))
    return result

add_rect(slide, 0.4, 1.55, 6.1, 5.7, WHITE)
add_rect(slide, 6.85, 1.55, 6.1, 5.7, WHITE)
add_multiline_textbox(slide, 0.5, 1.65, 5.9, 5.5, toc_lines(col_lines_left),
                      font_size=12, line_spacing_pt=16)
add_multiline_textbox(slide, 6.95, 1.65, 5.9, 5.5, toc_lines(col_lines_right),
                      font_size=12, line_spacing_pt=16)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 3 – INTRODUCTION & HISTORY
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Introduction", "A Paradigm Shift in Neurology")

add_rect(slide, 0.4, 1.55, 12.5, 5.7, WHITE)

intro_lines = [
    ("What is Autoimmune Encephalitis?", True, MED_BLUE, 17),
    ("", False, DARK_GRAY, 8),
    ("  • Brain inflammation caused by misdirected immune responses against neuronal or glial antigens", False, DARK_GRAY, 13),
    ("  • Distinct from infectious encephalitis – no pathogen; treatment is immunotherapy not antibiotics", False, DARK_GRAY, 13),
    ("  • NOW accounts for ~25% of all encephalitis cases – as common as infectious encephalitis", False, DARK_NAVY, 13),
    ("  • A TREATABLE cause of encephalopathy, psychosis, seizures, and movement disorders", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 8),
    ("Historical Milestones", True, MED_BLUE, 17),
    ("", False, DARK_GRAY, 8),
    ("  1960s–1990s:  Limbic encephalitis first described as a paraneoplastic syndrome", False, DARK_GRAY, 13),
    ("  2004:           VGKC antibodies identified in limbic encephalitis", False, DARK_GRAY, 13),
    ("  2007:           Anti-NMDA receptor encephalitis described by Dalmau et al.", False, DARK_GRAY, 13),
    ("  2010s:          Explosion of new antibody discoveries (LGI1, CASPR2, AMPAR, GABA-B...)", False, DARK_GRAY, 13),
    ("  2016:           Graus et al. publish consensus diagnostic criteria", False, DARK_GRAY, 13),
    ("  2020s:          Checkpoint inhibitor-related AE recognized; new biomarkers in development", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 8),
    ('  "Autoimmune encephalitis is now estimated to have an incidence similar to infectious encephalitis"', True, TEAL, 13),
    ("                                                              — Adams & Victor's Neurology, 12th Edition", False, TEAL, 11),
]
add_multiline_textbox(slide, 0.55, 1.65, 12.2, 5.5, intro_lines, line_spacing_pt=15)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 4 – EPIDEMIOLOGY
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Epidemiology", "Incidence, Demographics & Risk Factors")

# 4 stat boxes
stats = [
    (MED_BLUE,   "~25%",         "of all encephalitis\ncases are autoimmune"),
    (TEAL,       "1–2 / 100,000","annual incidence\n(comparable to viral encephalitis)"),
    (GREEN,      "F > M",        "Anti-NMDAR-E predominantly\nyoung women (F:M = 8:1)"),
    (ACCENT_RED, "38–56%",       "misdiagnosed initially\nas psychiatric illness"),
]
for i, (color, big, small) in enumerate(stats):
    x = 0.4 + i * 3.2
    add_rect(slide, x, 1.55, 3.0, 2.2, color)
    add_textbox(slide, x+0.1, 1.65, 2.8, 1.0, big,
                font_size=30, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_textbox(slide, x+0.1, 2.65, 2.8, 0.9, small,
                font_size=12, color=WHITE, align=PP_ALIGN.CENTER)

add_rect(slide, 0.4, 3.95, 12.5, 3.3, WHITE)
epi_lines = [
    ("Key Epidemiological Points", True, MED_BLUE, 16),
    ("", False, DARK_GRAY, 6),
    ("  • Anti-NMDAR encephalitis: most common autoimmune encephalitis; predominantly young women; associated with ovarian teratoma in 38–56%", False, DARK_GRAY, 13),
    ("  • Anti-LGI1 encephalitis: more common in older men (median age ~65 years); rarely paraneoplastic (<10%)", False, DARK_GRAY, 13),
    ("  • Paraneoplastic AE: overall incidence 0.5–1% of cancer patients; higher in SCLC (2–3%) and thymoma (30–50%)", False, DARK_GRAY, 13),
    ("  • In 60% of paraneoplastic cases, neurologic symptoms PRECEDE cancer diagnosis by months", False, DARK_GRAY, 13),
    ("  • Checkpoint inhibitor-associated AE: infrequent (~0.1–0.2%) but rising with immunotherapy use", False, DARK_GRAY, 13),
    ("  • Pediatric AE: often presents as new-onset refractory status epilepticus or acute psychiatric syndrome", False, DARK_GRAY, 13),
]
add_multiline_textbox(slide, 0.55, 4.05, 12.2, 3.1, epi_lines, line_spacing_pt=15)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 5 – CLASSIFICATION
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Classification of Autoimmune Encephalitis")

# Left box
add_rect(slide, 0.35, 1.55, 6.1, 5.7, WHITE)
left_lines = [
    ("By ANTIGEN LOCATION", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 6),
    ("CELL-SURFACE / SYNAPTIC ANTIGENS", True, TEAL, 13),
    ("  • Directly pathogenic – antibody binding alters receptor/channel function", False, DARK_GRAY, 12),
    ("  • Respond well to immunotherapy", False, GREEN, 12),
    ("  • Examples:", False, DARK_GRAY, 12),
    ("      – NMDA receptor (NR1 subunit)", False, DARK_GRAY, 12),
    ("      – LGI1 (VGKC-complex)", False, DARK_GRAY, 12),
    ("      – CASPR2, AMPA-R, GABA-A, GABA-B", False, DARK_GRAY, 12),
    ("      – DPPX, IgLON5, mGluR1, GlyR", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 6),
    ("INTRACELLULAR ANTIGENS (Onconeuronal)", True, ACCENT_RED, 13),
    ("  • T-cell mediated cytotoxicity – poorly reversible", False, DARK_GRAY, 12),
    ("  • Strong cancer association (>70%)", False, ACCENT_RED, 12),
    ("  • Examples:", False, DARK_GRAY, 12),
    ("      – Anti-Hu (ANNA-1): SCLC", False, DARK_GRAY, 12),
    ("      – Anti-Yo (PCA-1): Ovary, Breast", False, DARK_GRAY, 12),
    ("      – Anti-Ma2: Testicular seminoma", False, DARK_GRAY, 12),
    ("      – Anti-CV2 (CRMP-5): SCLC, Thymoma", False, DARK_GRAY, 12),
]
add_multiline_textbox(slide, 0.45, 1.65, 5.9, 5.5, left_lines, line_spacing_pt=14)

# Right box
add_rect(slide, 6.85, 1.55, 6.1, 5.7, WHITE)
right_lines = [
    ("By TUMOR ASSOCIATION (Harrison's 22e)", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 6),
    ("HIGH RISK  (>70% probability of cancer)", True, ACCENT_RED, 13),
    ("  Anti-Hu, Anti-Yo, Anti-Ri, Anti-CV2, Anti-Ma2, Anti-Tr", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 5),
    ("INTERMEDIATE RISK  (30–70%)", True, GOLD, 13),
    ("  Anti-NMDAR, Anti-AMPAR, Anti-GABA-B,", False, DARK_GRAY, 12),
    ("  Anti-GABA-A, Anti-glycine-R", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 5),
    ("LOW RISK  (<30%)", True, GREEN, 13),
    ("  Anti-LGI1, Anti-CASPR2, Anti-DPPX,", False, DARK_GRAY, 12),
    ("  Anti-GAD65, Anti-mGluR1, Anti-IgLON5", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 6),
    ("By ETIOLOGY", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("  ① Paraneoplastic (tumor-triggered)", False, DARK_GRAY, 12),
    ("  ② Non-paraneoplastic / Primary autoimmune", False, DARK_GRAY, 12),
    ("  ③ Secondary – Systemic autoimmune disease", False, DARK_GRAY, 12),
    ("      (Hashimoto, Sjogren, SLE, RA)", False, DARK_GRAY, 12),
    ("  ④ Immune checkpoint inhibitor-associated", False, DARK_GRAY, 12),
]
add_multiline_textbox(slide, 6.95, 1.65, 5.9, 5.5, right_lines, line_spacing_pt=14)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 6 – PATHOPHYSIOLOGY
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Pathophysiology", "How does the immune system attack the brain?")

add_rect(slide, 0.4, 1.55, 12.5, 5.7, WHITE)
path_lines = [
    ("CELL-SURFACE ANTIBODY MECHANISM (e.g., Anti-NMDAR)", True, MED_BLUE, 16),
    ("", False, DARK_GRAY, 5),
    ("  STEP 1:  Immune trigger – Tumor (ovarian teratoma expressing NR1) OR viral prodrome (HSV) OR unknown trigger", False, DARK_GRAY, 13),
    ("  STEP 2:  B-cells produce IgG antibodies against NR1 subunit of NMDA receptor", False, DARK_GRAY, 13),
    ("  STEP 3:  Antibodies cross blood-brain barrier → bind NMDA receptors on neurons", False, DARK_GRAY, 13),
    ("  STEP 4:  Receptor internalization / crosslinking → reduced NMDA-R surface density", False, DARK_GRAY, 13),
    ("  STEP 5:  Loss of NMDA-R function in GABAergic interneurons → DISINHIBITION of glutamate", False, DARK_GRAY, 13),
    ("  STEP 6:  Cortical hyperexcitability → seizures, psychosis, movement disorders", False, DARK_GRAY, 13),
    ("  STEP 7:  Antibody removal (immunotherapy / tumor resection) → clinical RECOVERY", False, GREEN, 13),
    ("", False, DARK_GRAY, 6),
    ("INTRACELLULAR ANTIGEN MECHANISM (e.g., Anti-Hu)", True, ACCENT_RED, 16),
    ("", False, DARK_GRAY, 5),
    ("  • Tumor expresses ectopic neuronal proteins → activates tumor-reactive T-cells", False, DARK_GRAY, 13),
    ("  • CD4+ and CD8+ T-cells infiltrate CNS → direct cytotoxic neuronal injury", False, DARK_GRAY, 13),
    ("  • Microglial activation + gliosis + irreversible neuronal loss", False, DARK_GRAY, 13),
    ("  • Antibodies are biomarkers; T-cells drive the damage → POOR response to immunotherapy", False, ACCENT_RED, 13),
    ("", False, DARK_GRAY, 5),
    ('  ⚡ Key clinical implication: Cell-surface AE is potentially FULLY REVERSIBLE; intracellular AE is not', True, TEAL, 13),
]
add_multiline_textbox(slide, 0.55, 1.65, 12.2, 5.5, path_lines, line_spacing_pt=14)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 7 – ANTI-NMDA RECEPTOR ENCEPHALITIS
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Anti-NMDA Receptor Encephalitis", "The Most Common Autoimmune Encephalitis")

add_rect(slide, 0.4, 1.55, 5.5, 5.7, WHITE)
nmda_left = [
    ("Who gets it?", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("  • Young women: F:M = 8:1", False, DARK_GRAY, 13),
    ("  • Median age ~21 years (all ages affected)", False, DARK_GRAY, 13),
    ("  • 38–56% have underlying ovarian teratoma", False, ACCENT_RED, 13),
    ("  • Men: rare; associated with testicular tumors", False, DARK_GRAY, 13),
    ("  • 5–10% post-HSV encephalitis relapse", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 6),
    ("Clinical Phases (Classic Progression)", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("  ① Prodrome (days):  Fever, headache, viral-like illness", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 3),
    ("  ② Psychiatric Phase (days–2 wks):", False, DARK_GRAY, 13),
    ("     Psychosis, agitation, hallucinations, delusions", False, DARK_GRAY, 12),
    ("     → Often FIRST seen by Psychiatry!", False, ACCENT_RED, 12),
    ("", False, DARK_GRAY, 3),
    ("  ③ Neurological Phase:", False, DARK_GRAY, 13),
    ("     Seizures (often refractory), movement disorder", False, DARK_GRAY, 12),
    ("     Orofacial dyskinesias, choreoathetosis", False, DARK_GRAY, 12),
    ("     Speech dysfunction → mutism", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 3),
    ("  ④ Unresponsive Phase:", False, DARK_GRAY, 13),
    ("     Decreased consciousness, autonomic instability", False, DARK_GRAY, 12),
    ("     Hyperthermia, tachycardia, central hypoventilation", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 3),
    ("  ⑤ Recovery Phase (weeks–months with treatment)", False, GREEN, 13),
]
add_multiline_textbox(slide, 0.5, 1.65, 5.3, 5.5, nmda_left, line_spacing_pt=13)

add_rect(slide, 6.2, 1.55, 6.7, 5.7, WHITE)
nmda_right = [
    ("Antibody & Mechanism", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("  • Target: NR1 subunit of GluN1 (NMDA receptor)", False, DARK_GRAY, 13),
    ("  • IgG1/IgG3 antibodies → crosslink & internalize receptors", False, DARK_GRAY, 13),
    ("  • Results in hypofrontality + dopamine dysregulation", False, DARK_GRAY, 13),
    ("  • Resembles NMDA antagonist effects (PCP, ketamine)", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 6),
    ("Investigations", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("  MRI Brain:  Often normal early; may show medial", False, DARK_GRAY, 13),
    ("  temporal FLAIR hyperintensity (30–50% of cases)", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 3),
    ("  CSF:  Lymphocytic pleocytosis (80%), elevated protein,", False, DARK_GRAY, 13),
    ("  oligoclonal bands (60%)", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 3),
    ("  EEG:  Delta-brush pattern (pathognomonic – 30%),", False, DARK_GRAY, 13),
    ("  generalized slowing, focal seizures", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 3),
    ("  Antibody:  ANTI-NR1 IgG in CSF > serum", False, DARK_GRAY, 13),
    ("  (CSF more sensitive for diagnosis!)", False, ACCENT_RED, 12),
    ("", False, DARK_GRAY, 6),
    ("Treatment", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("  1st Line:  IV methylprednisolone + IVIG or PLEX", False, DARK_GRAY, 13),
    ("  2nd Line:  Rituximab + cyclophosphamide", False, DARK_GRAY, 13),
    ("  Tumor:     Teratoma resection → rapid improvement", False, GREEN, 13),
    ("  Prognosis: 80% good outcome with early treatment", False, GREEN, 13),
]
add_multiline_textbox(slide, 6.3, 1.65, 6.5, 5.5, nmda_right, line_spacing_pt=13)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 8 – OTHER ANTIBODY SYNDROMES
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Other Major Antibody Syndromes", "LGI1 | CASPR2 | AMPAR | GABA-B | GABA-A")

rows = [
    ("ANTIBODY",    "DEMOGRAPHY",         "HALLMARK FEATURE",                "TUMOR ASSOC.",        "KEY POINTS"),
    ("Anti-LGI1",   "Older men 60–65y",  "Faciobrachial Dystonic Seizures\n(FBDS – pathognomonic)", "< 10%\n(Thymoma)", "FBDS precede LE; hyponatremia common;\nResponds well to steroids"),
    ("Anti-CASPR2", "Older men",          "Morvan syndrome\n(Neuromyotonia + AE + autonomic)", "< 20%\n(Thymoma)", "Peripheral nerve hyperexcitability;\nInsomnia; weight loss"),
    ("Anti-AMPAR",  "Middle-aged women", "Limbic encephalitis\nwith frequent relapses", "65–70%\n(Lung, Thymoma)", "RELAPSES common; aggressive\ntumor search essential"),
    ("Anti-GABA-B", "Older adults",       "Limbic encephalitis +\nSEIZURES dominant", "50%\n(SCLC)", "Seizures are the dominant feature;\nOften initially diagnosed as epilepsy"),
    ("Anti-GABA-A", "Variable",           "Severe limbic encephalitis\nrefractory seizures, MRI lesions", "< 10%\n(Thymoma)", "Widespread MRI lesions; FIRES-like\npresentation in children"),
    ("Anti-GAD65",  "Young women",        "Stiff-person syndrome\nCerebellar ataxia", "Rare\n(Type 1 DM)", "Association with Type 1 DM;\nPoorly responsive to immunotherapy"),
]

col_widths = [1.4, 1.8, 2.6, 1.6, 4.0]
col_x = [0.35, 1.77, 3.59, 6.21, 7.83]
row_h = 0.73
row_y = [1.55, 2.28, 3.01, 3.74, 4.47, 5.2, 5.93]

for r_idx, row in enumerate(rows):
    y = row_y[r_idx]
    bg = DARK_NAVY if r_idx == 0 else (WHITE if r_idx % 2 == 1 else LIGHT_BLUE)
    txt_color = WHITE if r_idx == 0 else DARK_GRAY
    b = (r_idx == 0)
    for c_idx, cell in enumerate(row):
        x = col_x[c_idx]
        w = col_widths[c_idx]
        add_rect(slide, x, y, w-0.04, row_h-0.02, bg)
        add_textbox(slide, x+0.05, y+0.03, w-0.12, row_h-0.06,
                    cell, font_size=10 if r_idx>0 else 11,
                    bold=b, color=txt_color)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 9 – CLINICAL PRESENTATION
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Clinical Presentation", "The FIRES Mnemonic & Symptom Domains")

# 5 domain boxes
domains = [
    (MED_BLUE,   "🧠 COGNITIVE",    "• Memory loss (amnesia)\n• Confusion / delirium\n• Cognitive decline\n• Disorientation"),
    (ACCENT_RED, "⚡ SEIZURES",     "• New-onset, refractory\n• Focal or generalized\n• Faciobrachial dystonic\n• Status epilepticus"),
    (TEAL,       "🎭 PSYCHIATRIC",  "• Psychosis, delusions\n• Hallucinations\n• Agitation, aggression\n• Mood disturbance"),
    (GOLD,       "🔄 MOVEMENT",     "• Orofacial dyskinesias\n• Choreoathetosis\n• Myoclonus\n• Catatonia / rigidity"),
    (GREEN,      "⚙️ AUTONOMIC",    "• Tachycardia / Brady\n• Hyperthermia\n• Central hypoventilation\n• Labile BP"),
]
for i, (col, title, text) in enumerate(domains):
    x = 0.35 + i * 2.55
    add_rect(slide, x, 1.55, 2.4, 1.0, col)
    add_textbox(slide, x+0.1, 1.6, 2.2, 0.85, title,
                font_size=13, bold=True, color=WHITE)
    add_rect(slide, x, 2.55, 2.4, 3.5, WHITE)
    add_textbox(slide, x+0.1, 2.6, 2.2, 3.35, text,
                font_size=11, color=DARK_GRAY)

add_rect(slide, 0.35, 6.2, 12.6, 1.05, WHITE)
sub_text = ("Subacute onset over DAYS TO WEEKS (< 3 months) is the hallmark. "
            "Rapid psychiatric → neurological progression in young women should trigger "
            "IMMEDIATE autoimmune encephalitis workup. "
            "In 60% of paraneoplastic cases, neurological symptoms PRECEDE cancer diagnosis. "
            "AE can also present as New-Onset Refractory Status Epilepticus (NORSE) or FIRES in children.")
add_textbox(slide, 0.45, 6.25, 12.4, 0.9, sub_text,
            font_size=11, color=DARK_GRAY, wrap=True)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 10 – APE2 SCORE
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "APE2 Score", "Antibody Prevalence in Epilepsy and Encephalopathy – Predicting Antibody Positivity")

add_rect(slide, 0.4, 1.55, 7.5, 5.7, WHITE)
ape2_items = [
    ("CRITERIA",                                                                      "POINTS"),
    ("New-onset rapidly progressive mental status changes (1–6 wks) or ± new-onset seizures", "+1"),
    ("Neuropsychiatric changes: agitation, aggressiveness, emotional lability",              "+1"),
    ("Autonomic dysfunction (tachycardia, bradycardia, orthostatic hypotension,\n  hyperhidrosis, labile BP, ventricular tachycardia, GI dysmotility)",                  "+1"),
    ("Viral prodrome (rhinorrhea, sore throat, low-grade fever) – if no cancer hx",          "+1"),
    ("Faciobrachial dystonic seizures (FBDS)",                                                "+3"),
    ("Facial dyskinesias (if no FBDS)",                                                       "+2"),
    ("Seizure refractory to ≥ 2 anti-seizure medications",                                    "+2"),
    ("CSF inflammation (protein > 50 mg/dL and/or lymphocytic pleocytosis > 5 cells/μL)",     "+2"),
    ("MRI suggesting encephalitis (FLAIR hyperintensity – medial temporal or multifocal)",     "+2"),
    ("Occurrence of the above 2 consecutive times within 3 months",                           "+3"),
    ("Underlying systemic malignancy within 5 years of onset",                                "+2"),
]
col_w_left  = [6.6, 0.6]
col_x_left  = [0.5, 7.1]
rh = 0.44
ry_start = 1.65
for r_idx, (crit, pts) in enumerate(ape2_items):
    y = ry_start + r_idx * rh
    bg = DARK_NAVY if r_idx == 0 else (LIGHT_BLUE if r_idx % 2 == 0 else WHITE)
    tc = WHITE if r_idx == 0 else DARK_GRAY
    add_rect(slide, col_x_left[0], y, col_w_left[0]-0.04, rh-0.02, bg)
    add_rect(slide, col_x_left[1], y, col_w_left[1]-0.04, rh-0.02, bg)
    add_textbox(slide, col_x_left[0]+0.06, y+0.02, col_w_left[0]-0.14, rh-0.04,
                crit, font_size=10 if r_idx>0 else 11, bold=(r_idx==0), color=tc)
    add_textbox(slide, col_x_left[1]+0.05, y+0.02, col_w_left[1]-0.1, rh-0.04,
                pts, font_size=11 if r_idx>0 else 11, bold=True,
                color=GOLD if r_idx>0 else WHITE, align=PP_ALIGN.CENTER)

# Right panel – score interpretation
add_rect(slide, 8.15, 1.55, 4.8, 5.7, WHITE)
score_interp = [
    ("Score Interpretation", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("  APE2 Score ≥ 4:", True, GREEN, 14),
    ("  99% sensitive, 93% specific for", False, DARK_GRAY, 13),
    ("  neural-specific antibody positivity", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 5),
    ("  Score < 4:", True, ACCENT_RED, 14),
    ("  Low probability of AE antibody", False, DARK_GRAY, 13),
    ("  (but does not exclude AE!)", False, ACCENT_RED, 12),
    ("", False, DARK_GRAY, 6),
    ("Clinical Use", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("  • Helps decide WHO to test", False, DARK_GRAY, 13),
    ("  • Guides urgency of workup", False, DARK_GRAY, 13),
    ("  • FBDS alone scores +3 –", False, DARK_GRAY, 13),
    ("    always test for LGI1!", False, ACCENT_RED, 13),
    ("", False, DARK_GRAY, 5),
    ("  Source: Washington Manual of", False, TEAL, 11),
    ("  Medical Therapeutics (Table 27-2)", False, TEAL, 11),
    ("", False, DARK_GRAY, 5),
    ("MAX SCORE = 19", True, DARK_NAVY, 16),
    ("Threshold ≥ 4 = INVESTIGATE!", True, ACCENT_RED, 14),
]
add_multiline_textbox(slide, 8.25, 1.65, 4.6, 5.5, score_interp, line_spacing_pt=14)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 11 – INVESTIGATIONS
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Investigations", "A Systematic, Parallel Approach")

inv_sections = [
    (MED_BLUE,   "🔬 BLOOD TESTS",
     "• CBC, CMP, LFT, TFT (exclude metabolic)\n• Autoimmune screen: ANA, ANCA, anti-dsDNA\n• HIV, syphilis, hepatitis serology\n• Serum antibody panel (NMDAR, LGI1, CASPR2, GABA-B, AMPAR)\n• Paraneoplastic panel (Hu, Yo, Ri, Ma2, CV2)\n• ESR, CRP, procalcitonin\n• Thyroid antibodies (Hashimoto encephalopathy)\n• Ammonia, lactate, B12, folate, homocysteine\n• Toxicology screen"),
    (TEAL,       "🧫 CSF ANALYSIS",
     "• Opening pressure, appearance\n• Cell count, differential (lymphocytic pleocytosis in 80%)\n• Protein (> 50 mg/dL, usually mildly elevated)\n• Glucose, culture, VDRL\n• Oligoclonal bands (60% in NMDAR-E)\n• CSF antibody panel – MORE SENSITIVE than serum\n• HSV/EBV/CMV/VZV/enteroviruses PCR\n• Flow cytometry if malignancy suspected\n• ALWAYS send BOTH serum AND CSF antibodies!"),
    (ACCENT_RED, "📡 NEUROIMAGING",
     "• MRI brain with contrast (FLAIR, DWI, T1+Gad, SWI)\n• FLAIR hyperintensity: medial temporal lobes (hippocampus)\n  → often bilateral; may be absent early in 50%\n• Rarely: multifocal cortical/subcortical lesions\n• DWI: restricted diffusion in acute phase\n• 18F-FDG PET: hypermetabolism in medial temporal lobes\n  with hypometabolism in parietal/occipital (NMDAR-E)\n• CT chest/abdomen/pelvis: tumor search\n• USS/MRI pelvis: ovarian teratoma in young women"),
    (GOLD,       "📊 EEG",
     "• Interictal slowing (most common finding)\n• Focal temporal discharges\n• DELTA BRUSH pattern: pathognomonic for\n  Anti-NMDAR-E (but only seen in 30%)\n• Seizure patterns: focal, multifocal, subclinical SE\n• Continuous EEG monitoring in ICU patients\n• FIRDA (Frontal intermittent rhythmic delta)"),
]
for i, (col, title, text) in enumerate(inv_sections):
    x = 0.35 + (i % 2) * 6.5
    y = 1.55 + (i // 2) * 2.9
    add_rect(slide, x, y, 6.35, 0.55, col)
    add_textbox(slide, x+0.1, y+0.05, 6.1, 0.45, title,
                font_size=14, bold=True, color=WHITE)
    add_rect(slide, x, y+0.55, 6.35, 2.25, WHITE)
    add_textbox(slide, x+0.1, y+0.6, 6.15, 2.1, text,
                font_size=10.5, color=DARK_GRAY)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 12 – MRI IMAGE SLIDE
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, DARK_NAVY)
section_header(slide, "Neuroimaging in Autoimmune Encephalitis", "MRI & PET Patterns")
add_rect(slide, 0, 1.42, 13.333, 0.07, GOLD)

# Fetch and embed images
image_urls = [
    "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_d0b713a748fe079f556119be499d1625a1ebf73c60e11cb3089d648fbcc1fd91.jpg",
    "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_b3e9aa901a3228d41e246f4376fe3bae8fce5dbd1a4f16aa192ed1aa911090b2.jpg",
]

try:
    result = json.loads(subprocess.check_output(
        ["python", "/tmp/skills/shared/scripts/fetch_images.py"] + image_urls,
        timeout=30
    ))
    img_positions = [(0.3, 1.55, 5.8, 4.5), (6.5, 1.55, 6.5, 4.5)]
    for idx, img in enumerate(result):
        if img.get("base64") and idx < 2:
            raw = base64.b64decode(img["base64"].split(",")[-1])
            bio = BytesIO(raw)
            l, t, w, h = img_positions[idx]
            slide.shapes.add_picture(bio, Inches(l), Inches(t), Inches(w), Inches(h))
except Exception as e:
    # Fallback text
    add_textbox(slide, 2, 2.5, 9, 1, f"[Images could not be loaded: {e}]",
                font_size=14, color=WHITE)

# Captions
add_rect(slide, 0.3, 6.1, 5.8, 0.9, MED_BLUE)
add_textbox(slide, 0.4, 6.12, 5.6, 0.85,
            "FLAIR & DWI: Anti-NMDAR-E\nRight temporo-occipital hyperintensity + pulvinar sign",
            font_size=10, color=WHITE)

add_rect(slide, 6.5, 6.1, 6.5, 0.9, TEAL)
add_textbox(slide, 6.6, 6.12, 6.3, 0.85,
            "18F-FDG PET: Temporal hypermetabolism (red/yellow) in NMDAR-E\nvs Basal ganglia hypermetabolism in LGI1-E",
            font_size=10, color=WHITE)
footer(slide, "Autoimmune Encephalitis | Neuroimaging | MD Medicine Neurology Seminar")


# ═══════════════════════════════════════════════════════════════
# SLIDE 13 – DIAGNOSTIC CRITERIA (GRAUS 2016)
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Diagnostic Criteria – Graus 2016", "Consensus approach to diagnosing Autoimmune Encephalitis")

add_rect(slide, 0.4, 1.55, 6.1, 5.7, WHITE)
graus_left = [
    ("POSSIBLE Autoimmune Encephalitis", True, MED_BLUE, 15),
    ("All 3 criteria met:", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 5),
    ("  1. Subacute onset (< 3 months):", False, DARK_GRAY, 13),
    ("     Working memory deficit, altered consciousness,", False, DARK_GRAY, 12),
    ("     OR psychiatric symptoms", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 3),
    ("  2. At least ONE of:", False, DARK_GRAY, 13),
    ("     a) New focal CNS findings", False, DARK_GRAY, 12),
    ("     b) Seizures (unexplained)", False, DARK_GRAY, 12),
    ("     c) CSF pleocytosis (> 5 WBC/μL)", False, DARK_GRAY, 12),
    ("     d) MRI suggesting encephalitis", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 3),
    ("  3. Reasonable exclusion of alternative causes", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 6),
    ("DEFINITE Autoimmune Encephalitis", True, GREEN, 15),
    ("", False, DARK_GRAY, 5),
    ("  • POSSIBLE AE + specific antibody identified", False, DARK_GRAY, 13),
    ("    in serum and/or CSF", False, DARK_GRAY, 12),
    ("  OR", True, DARK_GRAY, 12),
    ("  • Clinical syndrome fits defined phenotype", False, DARK_GRAY, 13),
    ("    (e.g., Anti-NMDAR-E criteria met)", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 5),
    ("  ⚠ ANTIBODY-NEGATIVE AE:", True, ACCENT_RED, 13),
    ("  Can still be diagnosed clinically if all", False, DARK_GRAY, 12),
    ("  other criteria met + infection excluded", False, DARK_GRAY, 12),
]
add_multiline_textbox(slide, 0.5, 1.65, 5.9, 5.5, graus_left, line_spacing_pt=13)

add_rect(slide, 6.85, 1.55, 6.1, 5.7, WHITE)
graus_right = [
    ("Antibody Testing Strategy", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("  ALWAYS test BOTH serum AND CSF", True, ACCENT_RED, 13),
    ("  (antibodies may be present in one but not both)", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 5),
    ("  CSF is MORE SENSITIVE for:", False, DARK_GRAY, 13),
    ("    • Anti-NMDAR (false negative serum in 15%)", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 3),
    ("  Serum more useful for:", False, DARK_GRAY, 13),
    ("    • Anti-LGI1, Anti-CASPR2", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 5),
    ("  Send ANTIBODY-NEGATIVE Samples to REFERENCE LAB", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 5),
    ("  Common AE Antibody Panels:", True, MED_BLUE, 14),
    ("", False, DARK_GRAY, 4),
    ("  CELL-SURFACE PANEL:", False, TEAL, 13),
    ("  NMDAR, LGI1, CASPR2, AMPAR,", False, DARK_GRAY, 12),
    ("  GABA-A, GABA-B, DPPX, VGKC", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 4),
    ("  PARANEOPLASTIC PANEL:", False, ACCENT_RED, 13),
    ("  Hu, Yo, Ri, Ma2, CV2, Amphiphysin,", False, DARK_GRAY, 12),
    ("  CRMP5, GAD65, SOX1, Tr (DNER)", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 5),
    ("  Timeline: Results may take 1–2 weeks", False, DARK_GRAY, 13),
    ("  → START TREATMENT EMPIRICALLY!", True, ACCENT_RED, 14),
]
add_multiline_textbox(slide, 6.95, 1.65, 5.9, 5.5, graus_right, line_spacing_pt=13)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 14 – DIFFERENTIAL DIAGNOSIS
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Differential Diagnosis", "AE can mimic many conditions – a broad DDx is essential")

dd_categories = [
    (ACCENT_RED, "INFECTIONS (MUST EXCLUDE FIRST)",
     "• Viral: HSV, EBV, CMV, VZV, VHFV, Japanese encephalitis, Rabies\n• Bacterial: TB meningitis, Listeria, neurosyphilis, Whipple disease\n• Fungal: Cryptococcal meningitis\n• Prion: Creutzfeldt-Jakob disease\n• Parasitic: CNS toxoplasmosis, cerebral malaria\n• ALWAYS start ACICLOVIR empirically until HSV PCR is negative!"),
    (MED_BLUE, "METABOLIC & TOXIC",
     "• Hepatic encephalopathy\n• Uraemic encephalopathy\n• Wernicke's encephalopathy (thiamine)\n• Hyponatraemia, hypercalcaemia\n• Drug toxicity: lithium, metronidazole, INH\n• Heavy metal poisoning\n• Septic encephalopathy"),
    (TEAL, "STRUCTURAL & VASCULAR",
     "• PRES (posterior reversible encephalopathy syndrome)\n• Bilateral temporal lobe infarcts\n• CNS vasculitis (primary or secondary)\n• ADEM (acute disseminated encephalomyelitis)\n• MS / NMOSD involving temporal lobes\n• CNS lymphoma or gliomatosis\n• Neurosarcoidosis"),
    (GOLD, "PSYCHIATRIC MIMICS",
     "• First-break psychosis / schizophrenia\n• Bipolar disorder with psychosis\n• Acute confusional state (delirium)\n• Catatonia (may coexist with AE)\n• Conversion disorder\n• Drug-induced psychosis (cannabis, meth, PCP)\n• NMDAR antagonists mimic NMDAR-E symptoms!"),
]
for i, (col, title, text) in enumerate(dd_categories):
    x = 0.35 + (i % 2) * 6.5
    y = 1.55 + (i // 2) * 2.9
    add_rect(slide, x, y, 6.35, 0.5, col)
    add_textbox(slide, x+0.1, y+0.04, 6.1, 0.42, title,
                font_size=13, bold=True, color=WHITE)
    add_rect(slide, x, y+0.5, 6.35, 2.3, WHITE)
    add_textbox(slide, x+0.1, y+0.55, 6.15, 2.15, text,
                font_size=10.5, color=DARK_GRAY)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 15 – TREATMENT: FIRST LINE
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Treatment: First-Line Immunotherapy", "Initiate EARLY – Do Not Wait for Antibody Results")

add_rect(slide, 0.4, 1.55, 12.5, 0.7, DARK_NAVY)
add_textbox(slide, 0.5, 1.6, 12.3, 0.6,
            "⚡ KEY PRINCIPLE: Start treatment empirically as soon as AE is suspected. "
            "Delay worsens outcomes. Treat SIMULTANEOUSLY with infection exclusion (Aciclovir + Empirical Antibiotics until cultures/PCR negative).",
            font_size=12, bold=True, color=GOLD)

agents = [
    (MED_BLUE,
     "IV METHYLPREDNISOLONE",
     "Dose:  1 g/day IV × 3–5 days\nThen: Oral prednisolone taper\n       (1 mg/kg/day → slow wean over months)\n\nMechanism: Anti-inflammatory; suppresses\nB-cell and T-cell activation\n\nMonitor: Blood glucose, BP, GI symptoms\nBone protection: Calcium + Vit D + PPI"),
    (TEAL,
     "INTRAVENOUS IMMUNOGLOBULIN (IVIG)",
     "Dose:  0.4 g/kg/day × 5 days\n       (total: 2 g/kg over 5 days)\n\nMechanism: Fc receptor blockade, complement\nneutralization, anti-idiotype antibodies\n\nOften given concurrently with steroids\n\nMonitor: Headache, aseptic meningitis,\nthrombosis (caution in high-risk patients)"),
    (ACCENT_RED,
     "PLASMA EXCHANGE (PLEX)",
     "Regimen:  5–7 exchanges over 10–14 days\n\nMechanism: Direct removal of pathogenic\nautoantibodies from circulation\n\nEquivalent efficacy to IVIG; use if:\n• No response to steroids in 5–7 days\n• Cannot tolerate IVIG\n• High antibody titers\n\nMonitor: Hemodynamics, clotting, lines"),
    (GREEN,
     "TUMOR TREATMENT",
     "Essential for paraneoplastic AE!\n\nOvarian teratoma (Anti-NMDAR-E):\n→ LAPAROSCOPIC RESECTION\n→ Often leads to rapid improvement!\n\nSCLC (Anti-Hu, GABA-B):\n→ Chemotherapy ± RT\n\nSearch: CT chest/abdomen/pelvis\n+ pelvic USS in all young women\n+ whole body FDG-PET if occult"),
]
for i, (col, title, text) in enumerate(agents):
    x = 0.35 + i * 3.2
    add_rect(slide, x, 2.35, 3.0, 0.55, col)
    add_textbox(slide, x+0.1, 2.38, 2.8, 0.5, title,
                font_size=12, bold=True, color=WHITE)
    add_rect(slide, x, 2.9, 3.0, 4.3, WHITE)
    add_textbox(slide, x+0.1, 2.95, 2.8, 4.15, text,
                font_size=11, color=DARK_GRAY)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 16 – TREATMENT: SECOND & THIRD LINE
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Treatment: Second & Third-Line Immunotherapy", "For Refractory or Severe Autoimmune Encephalitis")

add_rect(slide, 0.4, 1.55, 12.5, 5.7, WHITE)

tx_lines = [
    ("SECOND-LINE THERAPY (no improvement in 2–4 weeks on first-line)", True, MED_BLUE, 16),
    ("", False, DARK_GRAY, 5),
    ("RITUXIMAB (Anti-CD20 B-cell depleting monoclonal antibody)", True, MED_BLUE, 14),
    ("  Dose: 375 mg/m² IV weekly × 4 doses  OR  1000 mg IV × 2 doses (2 weeks apart)", False, DARK_GRAY, 13),
    ("  Evidence: Most evidence in anti-NMDAR-E; reduces relapse risk significantly", False, DARK_GRAY, 13),
    ("  Monitor: Infusion reactions, PML risk (JC virus), hepatitis B reactivation", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 5),
    ("CYCLOPHOSPHAMIDE", True, MED_BLUE, 14),
    ("  Dose: 750 mg/m² IV monthly × 3–6 cycles  (often combined with rituximab)", False, DARK_GRAY, 13),
    ("  Monitor: Hemorrhagic cystitis (mesna prophylaxis), myelosuppression, alopecia", False, DARK_GRAY, 13),
    ("  Use: Often in paraneoplastic AE with severe disease or intracellular antibodies", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 6),
    ("THIRD-LINE / REFRACTORY AE", True, ACCENT_RED, 16),
    ("", False, DARK_GRAY, 5),
    ("TOCILIZUMAB (Anti-IL-6 receptor monoclonal antibody)", True, ACCENT_RED, 14),
    ("  Dose: 8 mg/kg IV every 4 weeks", False, DARK_GRAY, 13),
    ("  Evidence: Promising case series; especially useful in anti-NMDAR-E refractory disease", False, DARK_GRAY, 13),
    ("  Mechanism: Blocks IL-6 signaling → reduces B-cell activation and antibody production", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 5),
    ("BORTEZOMIB (Proteasome inhibitor – plasma cell depleting)", True, ACCENT_RED, 14),
    ("  Depletes long-lived plasma cells producing pathogenic antibodies", False, DARK_GRAY, 13),
    ("  Case reports of dramatic improvement in otherwise refractory AE", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 5),
    ("MYCOPHENOLATE MOFETIL / AZATHIOPRINE  →  Long-term maintenance immunotherapy", True, TEAL, 13),
    ("  Used for relapse prevention; continue for 1–2 years after remission", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 4),
    ("  ⚠ Important: Anti-seizure medications alone are often INEFFECTIVE in AE-related seizures!", True, ACCENT_RED, 13),
    ("     Immunotherapy is the DEFINITIVE treatment for seizure control in AE.", False, DARK_GRAY, 12),
]
add_multiline_textbox(slide, 0.55, 1.65, 12.2, 5.5, tx_lines, line_spacing_pt=13)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 17 – CHECKPOINT INHIBITOR-ASSOCIATED AE
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Checkpoint Inhibitor-Associated AE", "Immune-Related Neurologic Adverse Events (irAE)")

add_rect(slide, 0.4, 1.55, 12.5, 5.7, WHITE)
ci_lines = [
    ("Background", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("  • PD-1 / PD-L1 / CTLA-4 inhibitors (pembrolizumab, nivolumab, ipilimumab) used in many cancers", False, DARK_GRAY, 13),
    ("  • Neurologic irAEs rare (~0.1–0.2%) but potentially severe and life-threatening", False, DARK_GRAY, 13),
    ("  • Any neurologic syndrome can occur: encephalitis, meningitis, neuropathy, myasthenia, myositis", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 6),
    ("Clinical Features", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("  • Encephalitis: confusion, personality change, seizures, cognitive decline", False, DARK_GRAY, 13),
    ("  • Limbic encephalitis: medial temporal involvement (as with other AE)", False, DARK_GRAY, 13),
    ("  • Antibodies: can be positive (NMDAR, LGI1, CASPR2, MOG) – often SERONEGATIVE", False, DARK_GRAY, 13),
    ("  • Onset: typically weeks to months after starting checkpoint inhibitor", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 6),
    ("Management (CTCAE Grading-Based)", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("  Grade 1 (mild):  Monitor closely; consider holding checkpoint inhibitor", False, DARK_GRAY, 13),
    ("  Grade 2 (moderate):  Hold checkpoint inhibitor; oral prednisone 1–2 mg/kg/day", False, DARK_GRAY, 13),
    ("  Grade 3–4 (severe):  PERMANENTLY DISCONTINUE checkpoint inhibitor", False, ACCENT_RED, 13),
    ("                        IV methylprednisolone 1–2 mg/kg/day; then oral taper", False, DARK_GRAY, 13),
    ("                        If no response in 48h: Add IVIG or PLEX", False, DARK_GRAY, 13),
    ("                        Consider rituximab for refractory cases", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 5),
    ("  ⚠ KEY: Multidisciplinary approach – Oncology + Neurology + Immunology", True, TEAL, 13),
    ("  ⚠ Stopping immunotherapy may compromise cancer treatment – careful risk-benefit analysis", True, ACCENT_RED, 13),
]
add_multiline_textbox(slide, 0.55, 1.65, 12.2, 5.5, ci_lines, line_spacing_pt=13)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 18 – SPECIAL POPULATIONS
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Special Populations", "Pediatric AE | AE in Pregnancy | Post-HSV AE")

add_rect(slide, 0.35, 1.55, 4.1, 5.7, WHITE)
ped_lines = [
    ("👶 PEDIATRIC AE", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("Most common: Anti-NMDAR-E", False, TEAL, 12),
    ("", False, DARK_GRAY, 4),
    ("Unique features:", True, DARK_GRAY, 13),
    ("• FIRES (Febrile Infection-related", False, DARK_GRAY, 12),
    ("  Epilepsy Syndrome) – test for AE!", False, DARK_GRAY, 12),
    ("• NORSE (New-Onset Refractory SE)", False, DARK_GRAY, 12),
    ("• Behavioural regression", False, DARK_GRAY, 12),
    ("• Hyperkinetic movements > adults", False, DARK_GRAY, 12),
    ("• Ovarian teratoma less common", False, DARK_GRAY, 12),
    ("  (consider but lower prevalence)", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 4),
    ("Treatment same as adults:", True, DARK_GRAY, 13),
    ("• IVIG: 2g/kg over 2–5 days", False, DARK_GRAY, 12),
    ("• Methylprednisolone 30mg/kg/d", False, DARK_GRAY, 12),
    ("  (max 1g) × 3–5 days", False, DARK_GRAY, 12),
    ("• Rituximab if refractory", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 4),
    ("Prognosis: Generally BETTER", False, GREEN, 12),
    ("than adults with early treatment", False, GREEN, 12),
]
add_multiline_textbox(slide, 0.45, 1.65, 3.9, 5.5, ped_lines, line_spacing_pt=13)

add_rect(slide, 4.65, 1.55, 4.1, 5.7, WHITE)
preg_lines = [
    ("🤰 AE IN PREGNANCY", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("Challenges:", True, DARK_GRAY, 13),
    ("• Diagnosis delayed (symptoms", False, DARK_GRAY, 12),
    ("  confused with eclampsia)", False, DARK_GRAY, 12),
    ("• Limited imaging (MRI preferred)", False, DARK_GRAY, 12),
    ("• Teratogenicity concerns", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 4),
    ("Safe in Pregnancy:", True, GREEN, 13),
    ("• IVIG: Safe in all trimesters", False, DARK_GRAY, 12),
    ("• PLEX: Safe; monitor hemodynamics", False, DARK_GRAY, 12),
    ("• Methylprednisolone (3rd trimester", False, DARK_GRAY, 12),
    ("  preferred; oral taper cautiously)", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 4),
    ("Caution / Avoid:", True, ACCENT_RED, 13),
    ("• Cyclophosphamide: teratogenic", False, DARK_GRAY, 12),
    ("• Rituximab: limited data, avoid", False, DARK_GRAY, 12),
    ("  unless life-threatening", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 4),
    ("Tumor search:", True, DARK_GRAY, 13),
    ("• USS pelvis (no radiation)", False, DARK_GRAY, 12),
    ("• MRI pelvis without contrast", False, DARK_GRAY, 12),
    ("• Teratoma resection postpartum", False, DARK_GRAY, 12),
    ("  unless severe deterioration", False, DARK_GRAY, 12),
]
add_multiline_textbox(slide, 4.75, 1.65, 3.9, 5.5, preg_lines, line_spacing_pt=13)

add_rect(slide, 8.95, 1.55, 4.0, 5.7, WHITE)
posthsv_lines = [
    ("🦠 POST-HSV AE", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("Mechanism:", True, DARK_GRAY, 13),
    ("• HSV encephalitis triggers", False, DARK_GRAY, 12),
    ("  autoimmune response against", False, DARK_GRAY, 12),
    ("  NMDA / GABA-B / AMPA receptors", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 4),
    ("Timing: 2–12 weeks after HSV", False, TEAL, 12),
    ("encephalitis treatment", False, TEAL, 12),
    ("", False, DARK_GRAY, 4),
    ("Features:", True, DARK_GRAY, 13),
    ("• RELAPSE after initial improvement", False, ACCENT_RED, 12),
    ("• Choreoathetosis (children)", False, DARK_GRAY, 12),
    ("• Psychiatric symptoms", False, DARK_GRAY, 12),
    ("• MRI: new or worsening lesions", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 4),
    ("TRAP: Often mistaken for", True, ACCENT_RED, 13),
    ("HSV encephalitis RELAPSE", True, ACCENT_RED, 12),
    "  → Repeat PCR is negative!",
    ("", False, DARK_GRAY, 4),
    ("Management:", True, DARK_GRAY, 13),
    ("• Continue Aciclovir while testing", False, DARK_GRAY, 12),
    ("• If PCR negative → Immunotherapy", False, GREEN, 12),
    ("• Early recognition = good outcome", False, GREEN, 12),
]
add_multiline_textbox(slide, 9.05, 1.65, 3.8, 5.5, posthsv_lines, line_spacing_pt=13)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 19 – PROGNOSIS & MONITORING
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Prognosis & Follow-up", "Recovery Timeline | Relapse | Monitoring")

# Prognosis boxes
prog_data = [
    (GREEN,      "~80%",     "Good neurological outcome\nwith early, aggressive treatment"),
    (MED_BLUE,   "20–30%",   "Require ICU care\n(ventilation, continuous EEG monitoring)"),
    (GOLD,       "20–25%",   "Relapse rate in anti-NMDAR-E\n(often milder than first episode)"),
    (ACCENT_RED, "5–10%",    "Mortality rate despite treatment\n(higher in paraneoplastic/intracellular AE)"),
]
for i, (col, big, small) in enumerate(prog_data):
    x = 0.35 + i * 3.2
    add_rect(slide, x, 1.55, 3.0, 1.85, col)
    add_textbox(slide, x+0.1, 1.6, 2.8, 0.85, big,
                font_size=32, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_textbox(slide, x+0.1, 2.45, 2.8, 0.85, small,
                font_size=11, color=WHITE, align=PP_ALIGN.CENTER)

add_rect(slide, 0.35, 3.55, 6.15, 3.7, WHITE)
prog_left = [
    ("Factors Predicting GOOD Outcome", True, GREEN, 15),
    ("", False, DARK_GRAY, 5),
    ("  ✔ Early initiation of immunotherapy", False, DARK_GRAY, 13),
    ("  ✔ Cell-surface antibody (vs. intracellular)", False, DARK_GRAY, 13),
    ("  ✔ Tumor removal (teratoma, thymoma)", False, DARK_GRAY, 13),
    ("  ✔ IVIG response within 1 week", False, DARK_GRAY, 13),
    ("  ✔ Mild initial clinical severity", False, DARK_GRAY, 13),
    ("  ✔ Younger age at onset", False, DARK_GRAY, 13),
    ("", False, DARK_GRAY, 6),
    ("Factors Predicting POOR Outcome", True, ACCENT_RED, 15),
    ("", False, DARK_GRAY, 5),
    ("  ✘ Intracellular onconeuronal antibodies", False, DARK_GRAY, 13),
    ("  ✘ Delayed diagnosis / treatment", False, DARK_GRAY, 13),
    ("  ✘ Underlying aggressive malignancy", False, DARK_GRAY, 13),
    ("  ✘ Prolonged ICU stay, central hypoventilation", False, DARK_GRAY, 13),
    ("  ✘ Refractory status epilepticus", False, DARK_GRAY, 13),
    ("  ✘ Older age (paraneoplastic)", False, DARK_GRAY, 13),
]
add_multiline_textbox(slide, 0.45, 3.65, 5.9, 3.5, prog_left, line_spacing_pt=13)

add_rect(slide, 6.85, 3.55, 6.15, 3.7, WHITE)
prog_right = [
    ("Follow-up & Monitoring Protocol", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("  During Treatment:", True, DARK_GRAY, 13),
    ("  • Antibody titers (CSF/serum) at 3 months", False, DARK_GRAY, 12),
    ("  • MRI brain at 3–6 months", False, DARK_GRAY, 12),
    ("  • EEG if seizures", False, DARK_GRAY, 12),
    ("  • Neuropsychological testing at 6–12 months", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 5),
    ("  Tumor Surveillance:", True, DARK_GRAY, 13),
    ("  • CT C/A/P every 6 months × 2 years", False, DARK_GRAY, 12),
    ("    (if initial tumor search negative)", False, DARK_GRAY, 12),
    ("  • Young women: Pelvic USS every 6 months", False, DARK_GRAY, 12),
    ("  • FDG-PET if occult malignancy suspected", False, DARK_GRAY, 12),
    ("", False, DARK_GRAY, 5),
    ("  Maintenance Therapy:", True, DARK_GRAY, 13),
    ("  • Mycophenolate or azathioprine × 1–2 years", False, DARK_GRAY, 12),
    ("  • Low-dose steroids taper slowly", False, DARK_GRAY, 12),
    ("  • Relapse: Repeat first-line immunotherapy", False, ACCENT_RED, 12),
]
add_multiline_textbox(slide, 6.95, 3.65, 5.9, 3.5, prog_right, line_spacing_pt=13)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 20 – MANAGEMENT ALGORITHM / FLOWCHART
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Clinical Management Algorithm", "Step-by-step approach to suspected Autoimmune Encephalitis")

steps = [
    (MED_BLUE,   "STEP 1: SUSPECT AE",
     "Subacute confusion + seizures + psychiatric Sx + movement disorder\nCalculate APE2 Score ≥ 4 → HIGH suspicion"),
    (TEAL,       "STEP 2: EXCLUDE INFECTIONS",
     "Blood cultures, LP (CSF PCR for HSV, bacteria)\nStart ACICLOVIR + Empirical antibiotics while awaiting results"),
    (GOLD,       "STEP 3: INVESTIGATIONS",
     "MRI Brain (FLAIR/DWI/contrast) | EEG (delta brush?)\nCSF + Serum antibody panels | Paraneoplastic screen\nCT C/A/P + Pelvic USS (young women)"),
    (GREEN,      "STEP 4: START IMMUNOTHERAPY",
     "Do NOT wait for antibody results!\nIV Methylprednisolone 1g/day × 3–5 days + IVIG 2g/kg over 5 days"),
    (ACCENT_RED, "STEP 5: REASSESS AT 2–4 WEEKS",
     "RESPONSE → Continue oral steroids + maintenance immunotherapy\nNO RESPONSE → 2nd line: Rituximab ± Cyclophosphamide"),
    (MED_BLUE,   "STEP 6: TUMOR TREATMENT",
     "Teratoma → Laparoscopic oophorectomy\nSCLC/Thymoma → Oncology referral for chemotherapy ± RT"),
]

box_w = 3.8
for i, (col, title, text) in enumerate(steps):
    row = i // 2
    col_idx = i % 2
    x = 0.4 + col_idx * 6.5
    y = 1.6 + row * 1.9
    add_rect(slide, x, y, box_w + 2.5, 0.45, col)
    add_textbox(slide, x+0.1, y+0.04, box_w + 2.35, 0.38, title,
                font_size=13, bold=True, color=WHITE)
    add_rect(slide, x, y+0.45, box_w + 2.5, 1.35, WHITE)
    add_textbox(slide, x+0.1, y+0.5, box_w + 2.35, 1.25, text,
                font_size=11, color=DARK_GRAY)

# Arrow notation
for i in range(2):
    for j in range(2):
        if i < 2 and j == 0:  # Only between rows in left column
            pass
add_textbox(slide, 6.0, 2.3, 0.5, 0.4, "►", font_size=24, color=MED_BLUE)
add_textbox(slide, 6.0, 4.2, 0.5, 0.4, "►", font_size=24, color=MED_BLUE)
add_textbox(slide, 6.0, 6.1, 0.5, 0.4, "►", font_size=24, color=MED_BLUE)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 21 – CASE VIGNETTE
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, DARK_NAVY)
section_header(slide, "Case Vignette", "Test your approach!")
add_rect(slide, 0, 1.42, 13.333, 0.07, GOLD)

add_rect(slide, 0.4, 1.58, 12.5, 2.55, RGBColor(0x1A, 0x2E, 0x45))
case_text = ("A 24-year-old female medical student presents with a 3-week history of:\n"
             "• Progressive confusion, insomnia, and bizarre behavior (seen by psychiatry 1 week ago, diagnosed as 'first-break psychosis')\n"
             "• Three generalized tonic-clonic seizures in the past 48 hours, refractory to lorazepam and levetiracetam\n"
             "• Orofacial and limb choreiform movements noted by her family\n"
             "• No fever, no neck stiffness. Prior viral URTI 4 weeks ago.\n"
             "• Pelvic USS: 3.5 cm right ovarian cystic mass (likely teratoma)")
add_textbox(slide, 0.55, 1.65, 12.2, 2.4, case_text,
            font_size=12, color=WHITE, wrap=True)

add_rect(slide, 0.4, 4.28, 12.5, 0.5, MED_BLUE)
add_textbox(slide, 0.5, 4.3, 12.3, 0.45,
            "INVESTIGATIONS: MRI Brain – subtle medial temporal FLAIR signal. "
            "CSF – 22 lymphocytes, protein 68 mg/dL, glucose normal. EEG – delta brush pattern. Serum NMDAR-Ab: NEGATIVE. CSF NMDAR-Ab: POSITIVE.",
            font_size=11, color=WHITE)

add_rect(slide, 0.4, 4.95, 12.5, 2.2, WHITE)
qns = [
    ("❓ Q1:", "What is the most likely diagnosis?", ACCENT_RED),
    ("✅ A1:", "Anti-NMDA Receptor Encephalitis (Seronegative serum; CSF antibody positive – always test CSF!)", GREEN),
    ("❓ Q2:", "What is the IMMEDIATE management?", ACCENT_RED),
    ("✅ A2:", "IV methylprednisolone 1g/day + IVIG 2g/kg; plan laparoscopic oophorectomy for teratoma; ICU monitoring", GREEN),
    ("❓ Q3:", "Why were seizures refractory to ASMs?", ACCENT_RED),
    ("✅ A3:", "AE seizures are antibody-mediated – ASMs alone inadequate; definitive treatment is IMMUNOTHERAPY", GREEN),
]
y_off = 5.02
for q_prefix, q_text, col in qns:
    add_textbox(slide, 0.55, y_off, 1.0, 0.3, q_prefix,
                font_size=11, bold=True, color=col)
    add_textbox(slide, 1.55, y_off, 11.2, 0.3, q_text,
                font_size=11, color=DARK_GRAY if q_prefix.startswith("✅") else DARK_NAVY,
                bold=(q_prefix.startswith("✅")))
    y_off += 0.33
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 22 – APPROACH TO THE ANTIBODY TABLE
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "Comprehensive Antibody Reference Table", "Antigen | Syndrome | Tumor | Key Feature")

rows2 = [
    ("ANTIBODY",    "SYNDROME",                      "TUMOR ASSOCIATION",       "PATHOGNOMONIC FEATURE"),
    ("NMDAR (NR1)", "Anti-NMDAR-E (limbic + movement)","Ovarian teratoma (38–56%)","Delta-brush EEG; orofacial dyskinesias"),
    ("LGI1",        "Limbic encephalitis",            "Thymoma (<10%)",           "Faciobrachial dystonic seizures (FBDS)"),
    ("CASPR2",      "Morvan syndrome / LE",           "Thymoma (<20%)",           "Neuromyotonia + insomnia + autonomic"),
    ("AMPAR",       "Limbic encephalitis",            "Lung, thymoma (65–70%)",   "Frequent relapses after immunotherapy"),
    ("GABA-B",      "Limbic encephalitis",            "SCLC (50%)",              "Seizures dominant feature"),
    ("GABA-A",      "Severe LE + status epilepticus", "Thymoma (<10%)",           "Widespread MRI lesions, FIRES-like"),
    ("Anti-Hu",     "Encephalomyelitis",              "SCLC (>95%)",             "Sensory neuronopathy; POOR prognosis"),
    ("Anti-Yo",     "Cerebellar degeneration",        "Ovary, breast (>95%)",     "Rapidly progressive cerebellar ataxia"),
    ("Anti-Ma2",    "Limbic + hypothalamic + BS enc.","Testicular (>70%)",        "Hypersomnia; young men"),
    ("GAD65",       "Stiff-person + cerebellar AE",   "Rare (Type 1 DM)",         "Poor response to immunotherapy"),
    ("GFAP",        "Meningoencephalomyelitis",       "Ovarian teratoma",         "Linear/radial perivascular FLAIR"),
    ("MOG",         "MOGAD / encephalomyelitis",      "Very rare",               "Cortical encephalitis; ADEM-like MRI"),
]

c_w = [1.8, 3.2, 2.7, 5.2]
c_x = [0.35, 2.17, 5.39, 8.11]
rh2 = 0.455
ry2_start = 1.55
for r_idx, row in enumerate(rows2):
    y = ry2_start + r_idx * rh2
    bg = DARK_NAVY if r_idx == 0 else (RGBColor(0xEB, 0xF5, 0xFF) if r_idx % 2 == 1 else WHITE)
    tc = WHITE if r_idx == 0 else DARK_GRAY
    b = (r_idx == 0)
    for c_idx, cell in enumerate(row):
        x = c_x[c_idx]
        w = c_w[c_idx]
        add_rect(slide, x, y, w-0.03, rh2-0.01, bg)
        add_textbox(slide, x+0.05, y+0.02, w-0.12, rh2-0.04,
                    cell, font_size=10 if r_idx>0 else 10, bold=b, color=tc)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 23 – KEY TAKEAWAYS
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, DARK_NAVY)
section_header(slide, "Key Takeaways", "5 Things Every Medicine Resident Must Remember")
add_rect(slide, 0, 1.42, 13.333, 0.07, GOLD)

takeaways = [
    (GOLD,       "1",
     "Autoimmune Encephalitis = TREATABLE cause of subacute neuropsychiatric syndrome",
     "Responsible for ~25% of all encephalitis. Incidence equals infectious encephalitis. Early diagnosis saves brains."),
    (MED_BLUE,   "2",
     "APE2 Score ≥ 4: Investigate immediately for AE antibodies",
     "Always send BOTH CSF AND serum. CSF is more sensitive for NMDAR-E. Do not rely on serum alone."),
    (TEAL,       "3",
     "Start treatment WITHOUT waiting for antibody results",
     "IV methylprednisolone + IVIG/PLEX. Empirical immunotherapy is safe. Delay causes irreversible damage."),
    (ACCENT_RED, "4",
     "Always search for an underlying tumor",
     "Ovarian teratoma (young women), SCLC, thymoma, testicular tumors. Tumor removal = key therapeutic step."),
    (GREEN,      "5",
     "ASMs alone WILL NOT CONTROL seizures in AE",
     "Seizures are antibody-mediated. Immunotherapy is the definitive seizure treatment. Continue escalating immunotherapy."),
]

for i, (col, num, heading, detail) in enumerate(takeaways):
    y = 1.62 + i * 1.1
    add_rect(slide, 0.4, y, 0.75, 0.95, col)
    add_textbox(slide, 0.4, y, 0.75, 0.95, num,
                font_size=32, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    add_rect(slide, 1.22, y, 11.7, 0.95, RGBColor(0x1A, 0x2E, 0x45))
    add_textbox(slide, 1.35, y+0.04, 11.4, 0.42, heading,
                font_size=14, bold=True, color=col)
    add_textbox(slide, 1.35, y+0.48, 11.4, 0.42, detail,
                font_size=11, color=RGBColor(0xCC, 0xDD, 0xEE))
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 24 – REFERENCES
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_BLUE)
section_header(slide, "References", "Key Sources Used in This Presentation")

add_rect(slide, 0.4, 1.55, 12.5, 5.7, WHITE)
refs = [
    ("Textbooks", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("  1. Adams and Victor's Principles of Neurology, 12th Edition. Ropper AH, et al. McGraw-Hill, 2023.", False, DARK_GRAY, 12),
    ("     Chapter 35: Autoimmune Encephalitis", False, DARK_GRAY, 11),
    ("", False, DARK_GRAY, 4),
    ("  2. Harrison's Principles of Internal Medicine, 22nd Edition. Loscalzo J, et al. McGraw-Hill, 2025.", False, DARK_GRAY, 12),
    ("     Chapter 99: Paraneoplastic Neurologic Syndromes and Autoimmune Encephalitis – Dalmau J, Graus F", False, DARK_GRAY, 11),
    ("", False, DARK_GRAY, 4),
    ("  3. Goldman-Cecil Medicine, 27th Edition (International Ed.). Goldman L, et al. Elsevier, 2024.", False, DARK_GRAY, 12),
    ("     Chapter 383: Autoimmune Encephalitis (Table 383-3: Antigen Targets)", False, DARK_GRAY, 11),
    ("", False, DARK_GRAY, 4),
    ("  4. Washington Manual of Medical Therapeutics, 37th Edition. Becker KJ, et al. Wolters Kluwer, 2022.", False, DARK_GRAY, 12),
    ("     Chapter 27: Autoimmune Encephalitis, APE2 Score (Table 27-2)", False, DARK_GRAY, 11),
    ("", False, DARK_GRAY, 6),
    ("Guidelines & Key Papers", True, MED_BLUE, 15),
    ("", False, DARK_GRAY, 5),
    ("  5. Graus F, et al. (2016). A clinical approach to diagnosis of autoimmune encephalitis.", False, DARK_GRAY, 12),
    ("     Lancet Neurology, 15(4):391–404. (Consensus Diagnostic Criteria)", False, DARK_GRAY, 11),
    ("", False, DARK_GRAY, 4),
    ("  6. Dalmau J, Graus F. (2018). Antibody-Mediated Encephalitis.", False, DARK_GRAY, 12),
    ("     NEJM, 378(9):840–851.", False, DARK_GRAY, 11),
    ("", False, DARK_GRAY, 4),
    ("  7. Guasp M, Dalmau J. (2025). Autoimmune Encephalitis.", False, DARK_GRAY, 12),
    ("     Med Clin North Am, 109(2). PMID: 39893022 [Review]", False, DARK_GRAY, 11),
    ("", False, DARK_GRAY, 4),
    ("  8. Abboud H, et al. Autoimmune Encephalitis: Proposed Best Practice Recommendations.", False, DARK_GRAY, 12),
    ("     J Neurol Neurosurg Psychiatry, 2021.", False, DARK_GRAY, 11),
]
add_multiline_textbox(slide, 0.55, 1.65, 12.2, 5.5, refs, line_spacing_pt=13)
footer(slide)


# ═══════════════════════════════════════════════════════════════
# SLIDE 25 – THANK YOU
# ═══════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_rect(slide, 0, 0, 13.333, 7.5, DARK_NAVY)
add_rect(slide, 0, 5.85, 13.333, 0.18, TEAL)
add_rect(slide, 0, 6.03, 13.333, 0.18, GOLD)

add_textbox(slide, 1.5, 1.5, 10.5, 1.2,
            "THANK YOU",
            font_size=64, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_textbox(slide, 1.5, 2.85, 10.5, 0.7,
            "Questions & Discussion",
            font_size=28, color=TEAL, align=PP_ALIGN.CENTER)
add_textbox(slide, 1.5, 3.65, 10.5, 0.5,
            "\"Early diagnosis and prompt immunotherapy remain the cornerstones of care.\"",
            font_size=16, italic=True,
            color=RGBColor(0xA8, 0xD8, 0xEA), align=PP_ALIGN.CENTER)
add_textbox(slide, 1.5, 4.3, 10.5, 0.5,
            "— Adams & Victor's Principles of Neurology, 12th Ed.",
            font_size=13, italic=True,
            color=RGBColor(0x7F, 0x9F, 0xBF), align=PP_ALIGN.CENTER)
add_textbox(slide, 1.5, 5.1, 10.5, 0.5,
            "MD Medicine Neurology Seminar  |  Department of Medicine",
            font_size=14, color=RGBColor(0xCC, 0xDD, 0xEE), align=PP_ALIGN.CENTER)


# ── SAVE ──────────────────────────────────────────────────────
output_path = "/tmp/workspace/autoimmune-encephalitis-ppt/Autoimmune_Encephalitis_Seminar.pptx"
buf = BytesIO()
prs.save(buf)
with open(output_path, "wb") as f:
    f.write(buf.getvalue())

print(f"SUCCESS: Saved to {output_path}")
print(f"Total slides: {len(prs.slides)}")

"""
Add medical images to the Autoimmune Encephalitis PPT.
Strategy:
  - Insert 4 new dedicated image slides at strategic positions
  - Also add inline thumbnail images to some text-heavy slides
"""

from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN
from io import BytesIO
import os, copy
from lxml import etree

IMG_DIR = "/tmp/workspace/autoimmune-encephalitis-ppt/images"
SRC     = "/tmp/workspace/autoimmune-encephalitis-ppt/Autoimmune_Encephalitis_Seminar.pptx"
OUT     = "/tmp/workspace/autoimmune-encephalitis-ppt/Autoimmune_Encephalitis_Seminar_v2.pptx"

# ── Colors ────────────────────────────────────────────────────
DARK_NAVY  = RGBColor(0x0D, 0x1B, 0x2A)
MED_BLUE   = RGBColor(0x1A, 0x6F, 0xAA)
LIGHT_BLUE = RGBColor(0xE8, 0xF4, 0xFD)
TEAL       = RGBColor(0x00, 0x8B, 0x8B)
ACCENT_RED = RGBColor(0xC0, 0x39, 0x2B)
WHITE      = RGBColor(0xFF, 0xFF, 0xFF)
DARK_GRAY  = RGBColor(0x2C, 0x3E, 0x50)
GOLD       = RGBColor(0xF3, 0x9C, 0x12)
GREEN      = RGBColor(0x1E, 0x8B, 0x4C)

def add_rect(slide, left, top, width, height, fill_color):
    shape = slide.shapes.add_shape(1,
        Inches(left), Inches(top), Inches(width), Inches(height))
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_color
    shape.line.fill.background()
    return shape

def add_text(slide, left, top, width, height, text, size=13,
             bold=False, color=DARK_GRAY, align=PP_ALIGN.LEFT,
             italic=False, wrap=True):
    tb = slide.shapes.add_textbox(
        Inches(left), Inches(top), Inches(width), Inches(height))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.margin_left = Pt(3); tf.margin_right = Pt(3)
    tf.margin_top = Pt(2);  tf.margin_bottom = Pt(2)
    p = tf.paragraphs[0]
    p.alignment = align
    r = p.add_run()
    r.text = text
    r.font.size = Pt(size)
    r.font.bold = bold
    r.font.italic = italic
    r.font.color.rgb = color
    r.font.name = "Calibri"
    return tb

def add_image(slide, path, left, top, width, height):
    if not os.path.exists(path):
        print(f"  WARNING: image not found: {path}")
        return None
    try:
        slide.shapes.add_picture(path, Inches(left), Inches(top),
                                  Inches(width), Inches(height))
        return True
    except Exception as e:
        print(f"  ERROR adding image {path}: {e}")
        return None

def header(slide, title, subtitle=""):
    add_rect(slide, 0, 0, 13.333, 1.35, DARK_NAVY)
    add_rect(slide, 0, 1.35, 13.333, 0.07, TEAL)
    add_text(slide, 0.35, 0.12, 12.5, 0.95, title,
             size=28, bold=True, color=WHITE)
    if subtitle:
        add_text(slide, 0.35, 0.88, 12.0, 0.45, subtitle,
                 size=13, color=RGBColor(0xA8, 0xD8, 0xEA))

def footer(slide, text="Autoimmune Encephalitis | MD Medicine Neurology Seminar"):
    add_rect(slide, 0, 7.15, 13.333, 0.35, DARK_NAVY)
    add_text(slide, 0.3, 7.17, 12.5, 0.28, text,
             size=9, color=RGBColor(0xB0, 0xC4, 0xDE))

# ── Load presentation ─────────────────────────────────────────
prs = Presentation(SRC)
blank = prs.slide_layouts[6]

# ─────────────────────────────────────────────────────────────
# NEW SLIDE A: MRI Patterns in Autoimmune Encephalitis
# Insert after slide 7 (NMDA-R slide, 0-indexed = 6) → position 7
# ─────────────────────────────────────────────────────────────
def make_mri_slide(prs, blank):
    s = prs.slides.add_slide(blank)
    add_rect(s, 0, 0, 13.333, 7.5, DARK_NAVY)
    header(s, "MRI Patterns in Autoimmune Encephalitis",
           "FLAIR hyperintensity – medial temporal lobes | LGI1 vs NMDAR-E")
    add_rect(s, 0, 1.42, 13.333, 0.07, GOLD)

    # Left image – NMDAR FLAIR progression
    add_image(s, f"{IMG_DIR}/mri_nmdar_flair.jpg", 0.3, 1.55, 5.9, 4.3)
    add_rect(s, 0.3, 5.85, 5.9, 1.3, MED_BLUE)
    add_text(s, 0.4, 5.88, 5.7, 1.24,
             "Anti-NMDAR Encephalitis – FLAIR Progression\n"
             "Left: Initial MRI – left hippocampal hyperintensity (acute edema)\n"
             "Right: Follow-up – hippocampal atrophy after immunotherapy\n"
             "⚑ MRI can be NORMAL in up to 50% of early NMDAR-E",
             size=10, color=WHITE)

    # Right image – LGI1 vs NMDAR comparison
    add_image(s, f"{IMG_DIR}/mri_lgi1_vs_nmdar.jpg", 6.9, 1.55, 6.1, 4.3)
    add_rect(s, 6.9, 5.85, 6.1, 1.3, TEAL)
    add_text(s, 7.0, 5.88, 5.9, 1.24,
             "NMDAR-E (top) vs LGI1-E (bottom) – MRI Comparison\n"
             "NMDAR-E: Bilateral amygdala/hippocampus – T2 signal without enhancement\n"
             "LGI1-E: Unilateral medial temporal hyperintensity (left hippocampus)\n"
             "⚑ Contrast enhancement is uncommon in both",
             size=10, color=WHITE)
    footer(s)
    return s

# NEW SLIDE B: EEG Delta Brush Pattern
def make_eeg_slide(prs, blank):
    s = prs.slides.add_slide(blank)
    add_rect(s, 0, 0, 13.333, 7.5, DARK_NAVY)
    header(s, "EEG: Extreme Delta Brush Pattern",
           "Pathognomonic for Anti-NMDAR Encephalitis | Present in ~30% of cases")
    add_rect(s, 0, 1.42, 13.333, 0.07, GOLD)

    # Left image – clean delta brush trace
    add_image(s, f"{IMG_DIR}/eeg_delta_brush.jpg", 0.3, 1.55, 6.2, 4.0)
    add_rect(s, 0.3, 5.55, 6.2, 1.6, MED_BLUE)
    add_text(s, 0.4, 5.58, 6.0, 1.55,
             "Extreme Delta Brush (EDB) Pattern\n"
             "• Rhythmic high-amplitude delta waves (1–3 Hz)\n"
             "• Superimposed fast beta bursts (20–30 Hz) on each delta wave\n"
             "• Bifrontal and bitemporal predominance\n"
             "• Differentiates movement disorder from subclinical status epilepticus",
             size=10.5, color=WHITE)

    # Right image – longitudinal EDB evolution
    add_image(s, f"{IMG_DIR}/eeg_delta_brush2.jpg", 6.8, 1.55, 6.2, 4.0)
    add_rect(s, 6.8, 5.55, 6.2, 1.6, TEAL)
    add_text(s, 6.9, 5.58, 6.0, 1.55,
             "EDB Evolution Under Treatment\n"
             "• Day 2: Unilateral EDB (right hemisphere)\n"
             "• Day 11: Bilateral EDB – worse before improvement\n"
             "• Day 30: Resolution with immunotherapy (normal alpha rhythm)\n"
             "• ASL perfusion: Focal hyperperfusion correlates with EDB location",
             size=10.5, color=WHITE)
    footer(s)
    return s

# NEW SLIDE C: PET Scan Patterns
def make_pet_slide(prs, blank):
    s = prs.slides.add_slide(blank)
    add_rect(s, 0, 0, 13.333, 7.5, DARK_NAVY)
    header(s, "18F-FDG PET in Autoimmune Encephalitis",
           "Metabolic signatures for NMDAR-E vs LGI1-E | More sensitive than MRI early on")
    add_rect(s, 0, 1.42, 13.333, 0.07, GOLD)

    # Left – limbic hypermetabolism
    add_image(s, f"{IMG_DIR}/pet_limbic.jpg", 0.3, 1.55, 4.0, 3.8)
    add_rect(s, 0.3, 5.35, 4.0, 1.8, MED_BLUE)
    add_text(s, 0.4, 5.38, 3.8, 1.72,
             "Limbic Encephalitis – FDG PET\n"
             "• Bilateral hypermetabolism in amygdala & hippocampus (red)\n"
             "• Characteristic of paraneoplastic limbic encephalitis\n"
             "• Differentiates from CJD (which shows parietal/occipital pattern)",
             size=10, color=WHITE)

    # Middle – NMDAR vs LGI1 comparison PET surface maps
    add_image(s, f"{IMG_DIR}/pet_nmdar_lgi1.jpg", 4.65, 1.55, 5.0, 3.8)
    add_rect(s, 4.65, 5.35, 5.0, 1.8, TEAL)
    add_text(s, 4.75, 5.38, 4.8, 1.72,
             "NMDAR-E vs LGI1-E – PET Surface Maps\n"
             "A: NMDAR-E – Frontotemporal hypermetabolism + parietal hypometabolism\n"
             "B: LGI1-E – Basal ganglia + cerebellar hypermetabolism\n"
             "C: Direct comparison – distinct metabolic fingerprints\n"
             "⚑ PET can distinguish antibody subtypes when antibodies unavailable",
             size=10, color=WHITE)

    # Right – parietal lesion (MRI-negative, PET-positive)
    add_image(s, f"{IMG_DIR}/pet_parietal.jpg", 9.95, 1.55, 3.05, 3.8)
    add_rect(s, 9.95, 5.35, 3.05, 1.8, ACCENT_RED)
    add_text(s, 10.05, 5.38, 2.85, 1.72,
             "MRI Negative – PET Positive\n"
             "• PET shows basal ganglia/temporal hypermetabolism\n"
             "• MRI sequences all unremarkable\n"
             "• PET detects AE BEFORE MRI changes appear!\n"
             "⚑ Order PET when MRI is normal but AE suspected",
             size=10, color=WHITE)
    footer(s)
    return s

# NEW SLIDE D: Clinical Clues Image Slide
def make_clinical_slide(prs, blank):
    s = prs.slides.add_slide(blank)
    add_rect(s, 0, 0, 13.333, 7.5, DARK_NAVY)
    header(s, "Clinical & Radiological Clues",
           "FBDS in LGI1-E | Ovarian Teratoma | Limbic Atrophy")
    add_rect(s, 0, 1.42, 13.333, 0.07, GOLD)

    # Left – FBDS clinical photo
    add_image(s, f"{IMG_DIR}/fbds_lgi1.jpg", 0.3, 1.55, 4.0, 4.2)
    add_rect(s, 0.3, 5.75, 4.0, 1.4, MED_BLUE)
    add_text(s, 0.4, 5.78, 3.8, 1.35,
             "Faciobrachial Dystonic Seizures (FBDS) – Anti-LGI1\n"
             "• Brief (<3s), frequent (>100/day), stereotyped\n"
             "• Facial grimacing + ipsilateral arm dystonia\n"
             "• PATHOGNOMONIC for LGI1-E (APE2 score +3!)\n"
             "• Treat with immunotherapy NOT just anti-seizure drugs",
             size=10, color=WHITE)

    # Middle – Ovarian teratoma + brain MRI
    add_image(s, f"{IMG_DIR}/ovarian_teratoma.jpg", 4.65, 1.55, 5.0, 4.2)
    add_rect(s, 4.65, 5.75, 5.0, 1.4, TEAL)
    add_text(s, 4.75, 5.78, 4.8, 1.35,
             "Ovarian Teratoma + Anti-NMDAR-E\n"
             "• USS/CT: mixed cystic-solid pelvic mass with fat & calcification\n"
             "• Brain MRI: corpus callosum lesion (cytotoxic edema) – CLOC\n"
             "• Day 52 MRI: COMPLETE RESOLUTION after teratoma removal\n"
             "⚑ Urgently resect teratoma → dramatic neurological improvement",
             size=10, color=WHITE)

    # Right – Limbic atrophy on follow-up
    add_image(s, f"{IMG_DIR}/mri_limbic_atrophy.jpg", 9.95, 1.55, 3.05, 4.2)
    add_rect(s, 9.95, 5.75, 3.05, 1.4, ACCENT_RED)
    add_text(s, 10.05, 5.78, 2.85, 1.35,
             "Limbic Encephalitis – Late Atrophy\n"
             "• Acute: hippocampal swelling + FLAIR signal\n"
             "• 6 months: hippocampal volume LOSS\n"
             "• Temporal horn dilatation (ex-vacuo)\n"
             "⚑ Delayed treatment → irreversible atrophy",
             size=10, color=WHITE)
    footer(s)
    return s

# ── Build the new image slides ────────────────────────────────
mri_slide   = make_mri_slide(prs, blank)
eeg_slide   = make_eeg_slide(prs, blank)
pet_slide   = make_pet_slide(prs, blank)
clin_slide  = make_clinical_slide(prs, blank)

# ── Reorder slides ────────────────────────────────────────────
# Current order after appending: original 25 slides + 4 new (indices 25-28)
# Target insertion positions (0-indexed, in final deck):
#   MRI slide  → after slide 7 (NMDA-R slide)          = index 8
#   EEG slide  → after slide 10 (Investigations slide)  = index 12 (shifted)
#   PET slide  → after EEG slide                        = index 13
#   Clinical   → after slide 8 (Other antibodies)       = index 10 (shifted)

def move_slide(prs, old_idx, new_idx):
    """Move slide at old_idx to new_idx in the presentation."""
    xml_slides = prs.slides._sldIdLst
    slides = list(xml_slides)
    slide_elem = slides[old_idx]
    xml_slides.remove(slide_elem)
    xml_slides.insert(new_idx, slide_elem)

total = len(prs.slides)
print(f"Total slides before reorder: {total}")

# Current indices of our 4 new slides (appended at end = 25,26,27,28)
# mri=25, eeg=26, pet=27, clin=28

# Step 1: Move MRI slide (currently at 25) → position 8 (after slide index 7 = NMDA slide)
move_slide(prs, 25, 8)
# Now: mri at 8, eeg at 26 (still last-1... but deck shifted), pet at 27, clin at 28... 
# Actually after moving mri, the remaining new slides shift: eeg=25, pet=26, clin=27

# Step 2: Move Clinical/FBDS slide → after slide index 9 (Other Antibodies, now at 9 after MRI insert)
# clin is currently at 27. Move to position 11
move_slide(prs, 27, 11)
# Now: mri@8, clin@11, eeg@25, pet@26 (shifted again)

# Step 3: Move EEG slide → after Investigations slide (originally slide 10, now ~14 after inserts)
# Investigations is 3rd from original position 10, now ~14. Put EEG at 16
move_slide(prs, 25, 16)
# eeg@16, pet@26 (shifted)

# Step 4: Move PET slide right after EEG → position 17
move_slide(prs, 26, 17)

print(f"Total slides after reorder: {len(prs.slides)}")

# ── Save ──────────────────────────────────────────────────────
buf = BytesIO()
prs.save(buf)
with open(OUT, "wb") as f:
    f.write(buf.getvalue())
print(f"Saved: {OUT}")

# Verify
prs2 = Presentation(OUT)
print(f"Verification – slides in final deck: {len(prs2.slides)}")