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What Is Maple Syrup Urine Disease? A Brilliant Minds Medical Mystery
Did a medical mystery ever smell so sweet?
There are never any easy answers for Dr. Wolf (Zachary Quinto) and the rest of the Brilliant Minds at Bronx General. Life is just too complicated for that. The season’s fourth episode, “The Blackout Bride,” sends Wolf and Dr. Kinney (Ashleigh LaThrop), Dr. Markus (Alex MacNicoll), Dr. Dang (Aury Krebs), and Dr. Nash (Spence Moore II) – his team of neurological interns – on a race against the clock to find a missing husband before it’s too late.
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The episode opens with a party: happy newlyweds celebrating their wedding day with dancing, drinking, and a sprinkling of recreational drugs. Then the bride shows up in the ER without her husband, without any memory of the evening, and covered in blood. The only words she can get out are “he has cold feet,” over and over.
Stress, PCP, and Murder on Brilliant Minds Episode 4
Caught up in the moment and not wanting the night to end, Bridget and Charlie (the bride and groom) ingested what they thought was MDMA, commonly known as Molly or Ecstasy. The next thing Bridget remembers, she was walking along the road before a car picked her up and delivered her to the hospital.
In an effort to get inside the mind of his patient, Wolf pops a pill.
“Putting myself in the same state of mind as the bride will help us understand what she’s trying to tell us. I can feel how she’s feeling, think how she’s thinking. We must see the world through her distorted lens,” Wolf says.
It’s an unorthodox strategy but it’s one that pays off. Wolf makes for Bridget and Charlie’s hotel room, with Dr. Dang in tow.
Back at the hospital, Bridget undergoes hypnotherapy to recover her memories of the evening. She remembers being happy, being hungry, dancing in the sky, and a room like ice. Following those clues, Wolf heads for the sleazy rooftop club at the hotel where he burns up the dance floor and breaks a guy's nose before a tox screen reveals that the MDMA was laced with PCP, known for causing sweating, paranoia, and rage.
As Wolf’s body temperature swings out of equilibrium, he feels almost compelled to walk into the freezer, which is when they realize what the bride meant by “a room like ice” and “he has cold feet.”
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They find Charlie in the walk-in freezer, stabbed and nearly frozen, but alive. Bridget still can’t remember what’s happened but she’s the prime suspect in what appears to be an attempted murder. Then a seizure unlocks her previously repressed memories, shedding light on the evening.
The couple were in the freezer, they got into an argument, and she stabbed Charlie with an ice pick. The case seems fairly open and shut: In a drug-fueled rage probably exacerbated by the stress of planning a wedding, Bridget snapped and stabbed her husband. Of course, the real answer is never that simple and Wolf won’t give up until he knows the truth.
Is "The Blackout Bride" based on a true story?
The episode takes some inspiration from an essay titled “Murder” in the book The Man Who Mistook His Wife for a Hat and Other Clinical Tales by neurologist Oliver Sacks (the real-life inspiration for Quinto’s Dr. Wolf). It follows a patient named Donald who killed his partner while under the influence of PCP. Despite the understanding that Donald wasn’t in control of his actions and didn’t even remember them, he was committed to a hospital for the criminally insane.
During his fifth year at the hospital, Donald started getting weekend passes. He bought a bike and during a roadside stroll, he was struck by a car, suffering a severe head injury. Donald spent two weeks in a coma and awoke to an entirely new hell. The memories of the murder returned all at once, seemingly a consequence of the head trauma. The memories were clear and vivid, tormenting Donald day and night.
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The precise reasoning for Donald’s actions, his repressed memories, and their sudden recovery remained a mystery, but on Brilliant Minds we get an answer for Bridget.
What is Maple Syrup Urine Disease?
A brain scan reveals that Bridget is suffering from cerebral edema (swelling on the brain) from an unknown source. A love letter from Charlie hinting at Bridget’s innately sweet aroma provides the final clue. She has a genetic disorder known as Maple Syrup Urine Disease (MSUD), an inherited metabolic disorder that inhibits the body’s ability to break down proteins.
MSUD particularly impact’s the body’s ability to process three amino acids found in protein: leucine, isoleucine, and valine. Ordinarily, when a person eats protein, the body produces enzymes to break the amino acids down into something the body can use. In MSUD, a genetic mutation means that your body doesn’t make those enzymes, or makes too little of them. Instead of breaking down, they accumulate in the body, eventually reaching toxic levels. The buildup of toxins shows up most readily as a characteristic syrupy smell in the urine, earwax, and sweat.
Classic MSUD is the most common form, and the most serious. Intolerance to that trio of amino acids is so severe that symptoms arise within days of birth. Intermediate MSUD is less severe and can take anywhere from several months to several years for symptoms to appear. Lastly, there’s intermittent MSUD, which is what we see on screen. Patients with intermediate MSUD can live comparatively ordinary lives without knowing anything is wrong, until another illness or period of stress causes the disease to blossom into a metabolic crisis.
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In addition to a syrupy smell, symptoms include muscle spasms in the head, neck, and spine, seizures, vomiting, neurological problems, chronic headaches, tremors and other movement disorders, loss of bone mass, brain damage, coma, and death. Fortunately, once diagnosed, patients can manage MSUD with a carefully regulated diet containing essential nutrients but lacking the troublesome amino acids. With treatment, patients can live relatively typical lives, provided they avoid protein, serious stress, and illegal drugs.
New episodes of Brilliant Minds premiere on Mondays on NBC at 10/9c and are available to stream on Peacock.
