For Pokche Prasad, the crowded emergency room of Patan Hospital was a familiar one, for he had often been rushed there in the past with the same symptoms � fever, severe headaches, and a bad pain in the neck. The doctors quickly treated him with intravenous antibiotics and Pokche walked away, 'cured' once more.

The doctors had diagnosed him long ago as suffering from meningitis � a life-threatening illness involving the inflammation of the thin tissue that surrounds the brain and spinal cord. But why Pokche was predisposed to suffer recurrent attacks could not be determined.

Until one day in the summer of 2009, when Pokche rushed into Dr Buddhi Poudyal's examining room and announced that he had a cold, but just in one nostril! Puzzled, Dr Poudyal examined him and saw that a thin clear fluid was indeed running out of one of the patient's nostrils. But Pokche exhibited no signs of a cold or respiratory infection.

Curious, the doctor had the discharge examined, only to discover that it was cerebrospinal fluid. This meant that there was a leak in the skull. Radiological scans of the head revealed a minor skull-base fracture. On questioning Pokche further, the doctor ascertained that the patient had sustained a slight head injury as a six-year-old boy, 22 years before his first episode of meningitis.

Cerebrospinal fluid (CSF) surrounds the brain and spinal cord. It acts like a liquid cushion, allowing the organs to be buoyant, and protects them from physical trauma. A skull fracture may create an opening between the nasal sinuses and the cranial cavity through which bacteria can travel and infect the meninges. In Pokche's case, CSF passed down into the nasal cavity and virulent bacteria from the nose sneaked up, triggering multiple meningitis. This time, he was successfully operated on and Pokche's visits to the hospital became a thing of the past.

A commonly held view in Nepal is that only children get meningitis and adults are immune to it. Not true. It is also believed that there is only one type of meningitis. Again, not true. Meningitis can be either bacterial or viral. These myths need to be debunked and those suffering from fever, headaches, stiff necks, vomiting, sleeplessness and light sensitivity should contact their doctors and have themselves also checked for meningitis; the symptoms are so similar to a multitude of other illnesses, it is often misdiagnosed.