Meningoencephalitis

Meningoencephalitis. What on earth is it? The doctors said I had it, lin the summer of 2010, and was lucky to survive it. But they couldn't tell me exactly what it was. Once the ambulance got me to the Royal London Hospital it turned out my heart was OK, my brain scans were fine, nothing came of tests for common viruses to less-common ones ranging from West Nile virus to atypical mycoplasma. However, for three days I was feverish and mentally on another planet

The gunge from my lumbar puncture contained some white blood cells, mostly lymphocytes, supporting if not fully establishing the diagnosis of probable meningoencephalitis -- a mysterious "viral infectious process of both the brain/spinal cord and the meninges."

A fair amount of the next two weeks was a feverish blur. I was incoherent, uncoordinated, and couldn’t produce the word “spoon” when the thing was brandished in my face. “You were not misbehaved,” Dee reported later. “You were just pulling your tubes out and things like that. But you were very courteous once you managed to slide out of bed, insisting, ‘Excuse me, excuse me,’ when you tried unsuccessfully to push your way through the nurses to the bathroom.”

I would think up things I wanted to tell Dee, but the words wouldn’t come. I knew exactly what I wanted to say and tried to form the words, which sometimes would start to form visually, then fade away as I snatched for them. Did stroke victims experience this kind of thing? Or people in comas? My goodness, I thought, maybe this is what it is to lose one’s mind! I was more bemused than frightened by the idea, no doubt because I didn’t believe it was true.

Poor Dee, she was afraid she would be widowed before we had been married a year. She was nearly right, though in the first week I was not aware of this, or much else either. I remember her spoon-feeding me, and coaching me on who I was, where I was, what day it was, and so on. There was no specific remedy or cure for what I had, which the doctors could only name as “lymphocytic meningoencephalitis,” provenance unknown. A virus had settled in the membrane that seals my brain from my skull, and was determined to colonize there. The neurologists had ordered a number of tests, and each day would visit my bed, perhaps four of them, and a ritual would begin. “What is your name?” “How old are you?” “Do you know where you are?” On one of these occasions I saw something happening in my peripheral vision and was amazed to see my hands waving about at the height of my temples. When this “myoclonic” spasm recurred the next day, the doctor said with some amazement, “Look, he’s flapping again.”

My bed was in a sparkling clean, modern semi-private ward, next to a large window. The window offered a fine view of the world, except that the view kept changing. Looking down, I could sometimes see Whitechapel Road, London, while at other times I saw Gibson Boulevard in Albuquerque, New Mexico. Or I would find myself staring out at that nonexistent train platform. Sometimes at night the window would look out onto a life-sized diorama that suggested a scene from the last days of the doomed King Charles I, similar to the images I fancied, crazily, that I could see etched in the high-tech ceiling lights. The nursing staff took note of all this, and I did my best to entertain them. Without exception they were a wonderful mix of people from Zimbabwe, Zambia, Nigeria, Sierra Leone, Congo, and other exotic places, and after three weeks I knew I would miss them. After daydreams about organizing parties for their children, after planning a chicken picnic together in Victoria Park, after dreaming up a song about drinking fictional jacaranda tea under the big blue-flowered trees in the parks of Bulawayo, how could I help it?

After a series of hallucinatory experiences, realistic daydreams, and imaginary adventures conjured up by my discoordinated gray matter, my condition at last began to improve. Slowly my neurons started to link up with each other, like jigsaw pieces self-assembling into a puzzlingly blank picture.

Finally my consultant neurologist allowed me out of my berth, first to a bedside chair (from which I was returned with a hoist), then with a Zimmer-frame walker, then the next day with no support at all. It may be that one of the antibiotics, or the anti-virus medicine, was taking effect, but no one knew for sure. Maybe I was recovering all by myself. The doctors were completely honest about this – “all we know is, you seem to be getting better, and that’s the main thing.”

Sixteen days after my admission they let me out, with a medical note that said I had suffered “probable viral meningoencephalitis” after being admitted with ”an acute history of confusion, fever and focal neurology including left-sided hemiparesis and dysphasia.”

Back at the flat, I would sit at my tiny computer next to the big sliding patio door, composing messages to my friends, but was greatly frustrated by the fact that my fingers didn't work right – their tips could not accurately strike the proper keys. There was panic until something marvelous happened. When I sat at a full-sized keyboard I could touch-type again! The author lives!

Still, what caused it? What part of the brain does the disease infect? How prevalent is it? The London doctors said I could have inhaled it from someone in the bus. A professor of neurology at Columbia University Medical Center helpfully explained meningitis and encephalitis but not the combination. The head of neurology at the University of New Mexico Medical School said much the same. A technical paper from Thailand, found on the Web, detailed the history of 11 patients who had died from meningoencephalitis: ten after eating raw snails and the 11th from eating the raw flesh of a python.

I appreciated most of all the comment from my mother's psychiatrist. "The behavioral effects of buggering someone's brain correlate with the location of the injury but not with the mechanism," he emailed me. "If the speech center is injured, one will have the same difficulties regardless of whether the injury was caused by a stroke, a virus or a baseball bat. In this case, all the big words just mean, "We don't know what the hell caused this, but it seems to have gone away."

Just what my London doctors said.