Solve the Medical Riddle: She Kept Losing Her Balance and She Had Memory Lapses, First 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.

We’ll start this week by letting you know what the patient told her PCP and how the doctor proceeded with the examination. Next week, the PCP and a neurologist will continue to look for clues to the medical riddle. The third week, we’ll let you know what some people have suggested as possible diagnoses. The fourth week, the doctor will reveal the actual diagnosis. Then we’ll move on to a new riddle for the following month!

The Patient Reports Her Symptoms

Carol, age 71, a former gymnast who still exercises regularly, has been having trouble with her balance. She has also noticed some memory lapses.

As always in ThirdAge Medical Riddles, the doctor uses 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 week, we’ll learn what Carol told her PCP:

“I used to be a competitive gymnast, so my balance has always been really good. I was a champ on the balance beam in my youth! I don’t attempt that these days, obviously, but I mall walk three times a week and I go to a barre fitness class on Saturdays. I’ve always felt really fit. Then about three months ago, I started having the sensation that I was losing my balance even when I was just standing up from a chair or going from the kitchen to the dining room. My gait is suddenly kind of funny, too, like I’m shuffling. Also, I’ve been having a lot more senior moments. Since I’m getting older, maybe my symptoms are just part of normal aging. Still, I thought I’d better get checked out!”



In addition to hearing Carol explain her symptoms, Carol’s doctor checked her health records and also questioned her. The doctor ascertained that Carol has no history of chronic headache or prior brain hemorrhage, no history of meningitis, and no major trauma or motor vehicle accidents.

The doctor explained to Carol that her symptoms are complex enough to require a complete evaluation. Fortunately, when Carol called to report her reasons for making an appointment, the doctor recommended a longer than normal visit to accommodate a thorough examination. In today’s busy practices, physicians often have a “panel” over 1,000 patients, and a doctor may get only six or seven minutes of contact time with each patient at a routine visit.

“You could be correct that your symptoms are simply part of normal aging,” the doctor told Carol. “However, you’ve always been healthy and active so I have reason to believe we need to look for possible conditions that could be causing the changes you’ve experienced. That’s why I made sure to tell the receptionist to give us a good block of time for this appointment.”


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