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

Last week, the patient reported her symptoms. The doctor proceeded with the examination using the components of the classic S-O-A-P notes, which are as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

The doctor also ordered blood work and other tests, referred Carol to a neurologist, and asked Carol to return for a second visit after getting the test results. This week, we’ll learn what happened during Carol’s return visit to her PCP and her appointment with the neurologist.

Carol’s PCP let her know that the results of the blood tests ruled out treatable thyroid disease as well as kidney and liver problems. However, Carol’s magnetic resonance imaging (MRI) showed enlarged ventricles. The doctor explained that the ventricles of the brain are filled with cerebrospinal fluid (CSF). At this point, the doctor was becoming even more sure of the diagnosis, but he still wanted Carol to keep her appointment with the neurologist.

The neurologist did a spinal tap to remove a large amount of fluid to see how Carol responded. Her symptoms did improve, which led the neurologist to believe he had a diagnosis and treatment plan. He consulted with Carol’s PCP, and they both had the same diagnosis in mind. Because the diagnosis for this condition is often not suspected until later, the physicians agreed that Carol was lucky to have classic symptoms and signs show up early . . .

To be continued . . .

Come back to next Thursday to find out what some people have guessed the diagnosis might be.  

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


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