22 DISCOVERMAGAZINE.COM
KELLIE^JAEGER/DISCOVERBY ELIEZER J. STERNBERGWHEN THE DOTS LINE UP
People often say that practicing medicine
is like connecting the dots, and the simpler
the line, the more plausible the hypoth-
esis. The first dot in this case: Melissa had
a history of depression and was on the
antidepressant Zoloft. The second dot: She
had exuberant, even manic symptoms. A
simple line connects them: bipolar disor-
der, the condition in which people have
both depressive and manic episodes.
The case would have seemed cut
and dried — just a bipolar patient with
her first manic episode — but the psy-
chiatrists sensed something was amiss.
Melissa was too old for this to be her first
manic episode, they explained. While
it’s possible to be diagnosed this late, it’s
highly unlikely.
And despite being on a low dose of an
antidepressant, she was generally a happy,
high-functioning person. Melissa was
religious, always with a Bible within arm’s
reach, but she’d never imposed her beliefs
on others or had religious delusions like
this before. Her sudden deterioration, the
psychiatrists argued, was less likely the
cause of a long-standing psychiatric con-
dition, but rather from a newly acquired
neurological one.
The psychiatrists specifically implied a
certain category of neurological disease
called encephalitis. It’s an inflammation
of the brain caused by infection, though
it can also be autoimmune in nature,
meaning the body’s immune system itself
attacks the brain. Encephalitis can affect
various regions, such as the brainstem
or frontal lobe, but the temporal lobes
(beneath the temples) are the most
common, and inflammation there leads
to a characteristic set of psychiatric
symptoms.
Patients with temporal lobe encepha-
litis, often called limbic encephalitis,
become confused, even psychotic. They
can behave like patients with mania or
new-onset schizophrenia, and they often
end up in psychiatric wards before doc-
tors realize their condition may actually
be neurological. Some of the telltale clues
are a fever or seizures, which are caused
by irritation of the temporal lobe. MelissaConnect the Dots
A woman’s sudden mania, odd sexual behavior
and furious note-taking don’t add up.I knew something was odd when the nurse insisted that
she accompany me into my patient’s room for my own
“protection” — but then again, this was the psych ward. The
nurse led me through two sets of metal doors to meet a glowing
46-year-old woman named Melissa — glowing not only because
of her orange blouse and tight, fluorescent blue pants, but also
because of her pasted-on smile, as if ecstatic to be involuntarily
hospitalized. She sat cross-legged on the bed with a Bible in her
lap, taking furious notes, until she noticed me standing there.
“Hello, doctor!” she said. “You have some sexy legs there,
don’t you?”
I don’t, and I was starting to get a sense of her symptoms.
Standing next to her was Anthony, her friend and co-worker,
who explained the situation. Melissa worked as a financial ana-
lyst and was typically a model employee, but today at work, her
colleagues became concerned that she had had a mental break-
down. She walked from office to office proclaiming, “I am God,”
and promising to forgive the sins of her “children” who worked
in the office. She repeatedly hugged her male colleagues while
declaring how much she loved their feet. Ultimately, Anthony
brought her to the hospital after she inquired about whether
he’d ever received a foot massage from the hands of God.People
often say
that
practicing
medicine
is like
connecting
the dots,
and the
simpler the
line, the
more
plausible
the
hypothesis.
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