Solve the Medical Riddle: She Constantly Feels as Though She’s Swaying and Rocking, Fourth Week

By Marie Savard MD

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

The first week of this riddle, the patient reported her symptoms and the doctor proceeded with the examination. This was step #1, S, of the classic the classic S-O-A-P notes as follows:
S=Symptoms or Chief Complaint
O=Objective Findings
A=Assessment or Analysis
P=Treatment Plan or Recommendations

The second week, the doctor moved on to O and A=Assessment or Analysis to continue to look for clues to the medical riddle. Last week, we let you know what some people had suggested as possible diagnoses. This week, the doctor will move on to P to reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

The Doctor Reveals the Diagnosis

Susan T. the person who thought her guess might be “crazy”, actually nailed the diagnosis! She called the condition “sea legs”, but the official name is “mal de debarquement” or “sickness of disembarking”. Usually, the symptoms last a few days or maybe weeks and then resolve. However, sometimes the duration of the condition is months or years, as in Judy’s case.

Judy’s MRI came back normal, so the neurologist and the PCP knew she didn’t have a brain tumor – not even a benign one such as an acoustic neuroma that Maureen W. mentioned or a benign meningioma that affects the membranes surrounding the brain and spinal cord.

The neurologist performed the following tests, all of which turned out to be normal:

• Caloric Test to see how responsive the vestibular system is
• Rotary Chair to assess balance function
• Audiogram to test for hearing loss
• Posturography to assess the ability to maintain balance

As it happens, mal de debarquement was in the news after Bernard Cohen M.D. and colleagues at Mt. Sinai in New York City published an article in July 2014 in Frontiers in Neurology detailing a new approach to treatment for the condition. The team wrote: “Subjects were treated by rolling the head from side-to-side while watching a rotating full-field visual stimulus. Seventeen of the 24 subjects had a complete or substantial recovery on average for approximately 1 year. Six were initially better, but the symptoms recurred. One subject did not respond to treatment. Thus, readaptation of the VOR [vestibular-ocular reflex] has led to a cure or substantial improvement in 70% of the subjects with MdDS. We conclude that the adaptive processes associated with roll-while-rotating are responsible for producing MdDS, and that the symptoms can be reduced or resolved by readapting the VOR.”

As for Judy, her condition spontaneously resolved even though she had had it for two years. As she put it: “I have a feeling that taking those sedatives in order to get some sleep plus finding out that nothing serious was wrong with me just combined to calm me down so that I stopped stressing, which was probably making my condition worse. I really do finally have my land legs back but I can tell you for sure that I’m never getting on a boat again in my life! I don’t want to risk a recurrence of that weird disembarking malady. For our 35th anniversary, we’re going to a beach resort that’s driving distance from our home!”

Come back to ThirdAge.com next Thursday when we’ll introduce a new medical riddle!

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Pleas visit DrSavard.com.