26 Apr 2020 A life saved: Couple thankful for doctors’ actions
by John Patton
Brad Rusher had not felt well for a couple of weeks but had attributed those feelings to being stressed out from the pressures of life. He was working full time while his wife, Jennifer, worked part time in the Conway Regional Imaging Department and homeschooled their children. They were also selling their old house and building a new one.
Brad learned that his condition was, in fact, something more serious. He experienced a piercing headache while working on their property north of Greenbrier on a Saturday. The headaches would come and go and he continued to feel tired. Attributing his condition to stress and being “run down,” he pushed through the work that weekend.
When Jennifer came home from work Monday morning, Brad was continuing to feel bad. She was running errands, when he sent a text saying he couldn’t get up. Jennifer rushed home and a friend met her there to help get Brad to the car. “He was talking out of his head, disoriented and mixing up words,” Jennifer said. Worried that Brad was experiencing a stroke, Jennifer drove him to the emergency room.
Brad awoke five days later with no memory of what had happened. “I woke up in the hospital and wondering why nobody had come to see me, and she said, ‘It’s Saturday.’”
Jennifer filled in the blanks. Brad owed his life to Conway Regional physicians who prescribed acyclovir, a medicine that treats certain types of infections, including one that is caused by HSV1 meningoencephalitis.
When the Rushers arrived at the ER, the staff began a series of tests based on his initial symptoms. Dr. Wade Gregory ordered blood work, a CT scan and an MRI, but something about Brad’s case was not adding up for Gregory and Dr. Keith Schluterman, a neurologist with the Conway Regional Neuroscience Center. “We were suspicious of infection from the beginning as he had a low-grade fever and his presentation and age made stroke a less likely cause. The blood work and CT came back relatively unremarkable, but his CSF studies and MRI were still pending,” said Gregory. Broad-spectrum antibiotics and acyclovir (and anti-viral medication) were given while awaiting the test results.
Shortly afterward, Brad’s blood pressure spiked and he experienced a 45-second grand mal seizure, which is caused by abnormal electrical activity in the brain. Once he was sedated, a lumbar puncture was ordered and performed by Gregory in the ER before Brad was moved to a critical care unit. On Thursday night, the test results came back from the Mayo Clinic and the mystery illness was diagnosed by Schluterman as HSV1 meningoencephalitis. It is inflammation of the brain and meninges (membranous covering of the brain and spinal cord), typically caused by an infection. Brad’s infection occurred when a virus invaded his brain and meninges.
“Dr. Schluterman said he has a patient with this condition, maybe once every three years at Conway Regional,” Jennifer said. It is typically present in patients whose immune systems have been suppressed, such as people with cancer or HIV. “He said the great news is that we started acyclovir immediately and that is the drug that treats it,” she added.
Brad spent the next 21 days on acyclovir before a second episode of headaches sent him back to the Conway Regional Emergency Department. “Jennifer called me with questions about what to do,” said Gregory, “and we brought him back to the ER.” Brad went through another round of testing, including a repeat lumbar puncture, to determine if the infection had returned. The tests showed some increased inflammation of the brain.
Gregory consulted with colleagues at the University of Arkansas for Medical Sciences and a determination was made that he should go to UAMS, where a specialized treatment regimen was available. “We only went there because the treatment is only offered at a few specialized hospital centers and wasn’t available in Conway,” said Jennifer.
“Even at UAMS, they said they hardly ever see this in healthy people. Brad was kind of a celebrity because the residents don’t typically see it in 39-year-old healthy individuals. This is the kind of thing medical students read about in the textbooks,” said Jennifer.
“HSV1 is an extremely common virus but it will rarely infect the brain,” said Schluterman. “It’s more common in folks as they get older or they become immunocompromised, so it’s unusual to have a young, healthy person encounter this.
“HSV1 does not usually cause meningitis (an infection of the membranous lining of the brain); it more typically causes only encephalitis (infection of the brain). Brad had both. When I looked at his symptoms and tried to put it all together, he demonstrated symptoms of meningitis including headaches. The encephalitis caused the confusion, difficulties remembering and finding the right words in speech, and seizures.”
Lucky
Schluterman added, “Brad was probably lucky that he had his seizure in the ER. The fact that he had confusion and a seizure in the ER led us to do additional tests.”
“As Dr. Schluterman explained it, the virus basically goes into your brain and destroys brain tissue and the longer there is a delay in treatment the more brain damage you will have,” said Jennifer. “The fact that the doctors felt like Brad needed to be treated for meningoencephalitis days before the actual results came in saved his life.”
Eight months later, Brad has some short-term memory loss and will take seizure medicine indefinitely. It could have been much worse. “HSV1 has as much as a 70 percent mortality rate in healthy people without treatment and some of the survivors have significant brain damage,” said Jennifer.
Brad has been able to return to work at Edafio Technology Partners and resume life with Jennifer and their three children: Abbie, 16, Braden, 14, and Emma, 10. There are some restrictions. Under Arkansas state law, a person can’t drive until one year after a seizure. Jennifer quipped, “We call it Driving Brad Rusher” in reference to the Oscar-winning movie “Driving Miss Daisy.”
“I have an overwhelming sense of thankfulness for the doctors who took care of him,” said Jennifer. “I have worked for Conway Regional for 18 years, and I have seen many lives saved, but what they do when someone you love is lying there, it is different. Dr. Gregory and Dr. Schluterman will always have a special place in my heart.
“I feel like if we had gone to a larger hospital that day this could have been overlooked,” she added. “All of his blood work was normal; but they just knew something was not right. They listened to me. I feel like it is our responsibility to tell our story.”
Gregory added, “I considered this like taking care of a family member. It meant a lot to me to be able to take care of them, but he was not healed through some power of mine. His recovery can be attributed to providence and God. I’m really glad Brad is doing so well.”
The Rushers agree. “We truly believe that God gave Dr. Gregory and Dr. Schluterman the experience and wisdom to know what to do in a ‘not so typical’ situation,” said Jennifer.
The Rushers also came away from the near-death experience with a renewed appreciation for their community. “We had 60 people show up and move our entire house in four hours because we were in the hospital and had a deadline to meet,” Jennifer said. “They were amazing; people from our home school cooperative and church. I have a photo of our amazing community standing in the Penske truck.”
Brad added, “It’s definitely changed the way I look at life. It was almost like a dream. I’m very grateful to be alive. It helped me realize that life is very fragile and we should appreciate what we have.”
Take away
Jennifer encourages anyone who is experiencing unusual health symptoms to trust their intuition and see a physician. “Brad was so stubborn and wouldn’t go to the ER initially. He was working with a bad headache on Saturday and things progressed so quickly that by Monday he was asking to go to the ER. I tell my patients all the time it is better to err on the side of caution. It’s better to be safe than sorry because it can literally be the difference between life and death,” said Jennifer.
She added, “You don’t have to go to Little Rock to get top-notch care. Conway Regional is home to some of the best physicians in the country. It was these doctors who diagnosed, treated and ultimately saved Brad’s life.”
