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


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.”