Solve the Medical Riddle: She Kept Losing Her Balance and She Had Memory Lapses, Third 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 to her PCP. The doctor proceeded with the examination using 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

This second week, the doctor reviewed the results of Carol’s tests and a neurologist did a spinal tap. This week, we’ll let you know what some people have suggested as possible diagnoses. Next week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

Some Guesses as to What the Diagnosis Will Be

“Except for the fact that Carol doesn’t seem to have tremors, I’m guessing she could have Parkinson’s disease. My cousin’s husband has PD and he has the same kind of problems with walking that Carol has. In fact, my cousin and her husband had been planning to retire to Manhattan near Lincoln Center because they love the arts, but New York is a walking town. On their last visit there, he really couldn’t get anywhere on foot. They were always taking taxis. He is still able to drive so they decided to stay where they are on Long Island. Also, he does seem to me to have mild dementia, but we never talk about that. It’s kind of taboo in our family. Of course I‘m not a doctor and I have no idea what that spinal tap Carol had could mean. I also don’t know if my cousin’s husband ever had one of those. This is just a guess!”

— Donna R.

“I once had a weird condition called ‘ear rock’. It’s most common in people over 50 and can result from head trauma or viral infections. Carol said she never had any trauma, but maybe she had a virus and didn’t think it was significant enough to report to her doctor. That was my story exactly. The medical term for ear rock is bipolar paroxysmal positional vertigo. Some of the little crystals in your inner ear break loose and rattle around in the wrong places in your ear. This sends confusing messages to your brain so you get what feels like vertigo and your gait is unsteady. I went to a physical therapist who showed me exercises that would get the ‘rocks’ back in the right place. I also took some medication for nausea. The whole problem resolved completely in a few weeks. I hope Carol has something that simple and not too serious!”

— Alexandra T.

“Carol does apparently have mild cognitive impairment so maybe she is in the early stages of Alzheimer’s. I don’t wish that on anyone, though! I am the caregiver for my mother who isn’t much older than Carol. AD is a sad disease. My mother was so bright and vibrant! Now she is like a shell of her former self. Fingers crossed that Carol has something less devastating.”

— Lillian S.

“Could Carol have had a little stroke without even knowing it? My brother had a transient ischemic attack, a TIA, and he wasn’t diagnosed until he went to the doctor because his left leg wasn’t working the way it should have. He was walking funny and he had balance problems. He didn’t have memory problems though, and intense physical therapy truly helped him. The good news is that  the TIA scared him straight when it came to lifestyle choices! Now he eats much better, he quit smoking, he exercises three times a week, and he has cut back on the Jack Daniels!”

— Ginger P.

To be continued . . .

Come back to ThirdAge.com next Thursday when the doctor will reveal the actual diagnosis and treatment plan.

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. Please visit DrSavard.com.