Intermittent bursts of abdominal wall jerky movements: belly … · Intermittent bursts of...

Intermittent bursts of abdominal wall jerkymovements belly dancerrsquos syndromeOsama S M Amin1 Qalandaar Hussein Abdulkarim2 Mohammad Shaikhani3

1Department of NeurologySulaimaniya General TeachingHospital Sulaimaniya City Iraq2Department of SurgerySulaimaniya General TeachingHospital Sulaimaniya City Iraq3Department of InternalMedicine Sulaimaniya GeneralTeaching Hospital SulaimaniyaCity Iraq

Correspondence toDr Osama S M Amindrosamaamingmailcom

To cite Amin OSMAbdulkarim QHShaikhani M BMJ CaseReports Published online 24December 2012doi101136bcr-2012-007393

DESCRIPTIONA 47-year-old Iraqi Kurdish woman presented witha 1-day history of sudden onset of frequent inter-mittent and painful abdominal wall jerky move-ments 6 days after undergoing haemorrhoidectmyDuring sleep these movements were absent Thepostoperative period was uneventful and thepatient was discharged home on day 2 with oralclindamycine and metronidazole The appearanceof these movements prompted the AampE interns tothink about intestinal obstruction and accordinglythey consulted the general surgical department thesurgeon suggested symptomatic treatment withwatchful waiting and nothing by mouth Howeveron day 3 we were asked to examine the patientthese movements (video 1) represented bellydancerrsquos syndrome Brain and spinal MRI wereunremarkable as were her blood tests chest CTscan and transthoracic echocardiography diaphrag-matic fluoroscopy and abdominal walldiaphrag-matic electromyography were not done She wasprescribed intravenous diphenhydramine and oraldiazepam her complaints disappeared completely3 days later and have never recurred

Belly dancerrsquos syndrome (or diaphragmaticflutter) refers to myoclonic jerks involving one orboth hemidiaphragms which are involuntary repeti-tive usually painful and often rhythmic and resultin visible undulating movements of the abdomen(and sometimes the trunk) an appearance whichresembles belly dance The condition is rare and hasa long list of causes The core feature is a rapid myo-clonic contraction and release of the diaphragmwhich in most cases involves both inspiration andexpiration The majority is bilateral but unilateralcases usually target the left side The abdomen isusually painful and the dyspnoea is frequently aprominent complaint1ndash3

Learning points

Belly dancerrsquos syndrome is a form ofdiaphragmatic myoclonic jerks (or flutter)which can result in chest andor abdominalpain and dyspnoea Therefore an alternativediagnosis usually comes to mind

Clinically frequent intermittent and oftenrhythmic involuntary undulations of theabdomen are observed

Diaphragmatic fluoroscopy andelectromyography are the key diagnostic toolsIn spite of the long list of pathologicallydefined causes behind this syndrome severalcases are idiopathic and some are psychogenic

Competing interests None

Patient consent Obtained

Provenance and peer review Not commissioned externally peerreviewed

REFERENCES1 Rigatto M De Medeiros NP Diaphragmatic flutter report of a case

and review of the literature Am J Med 196232103ndash92 Kobayashi I Tazaki G Hayama N et al A case of the

diaphragmatic flutter with an electromyographic study of therespiratory muscles Tokai J Exp Clin Med 200429151ndash4

3 Linazasoro G Blercom N Lasa A et al Etiological andtherapeutical observations in a case of belly dancerrsquos dyskinesiaMov Disord 200520251ndash3

Video 1 Note the undulating movements of theanterior abdominal wall muscles which are moreprominent on the left side and resemble belly dancingThis is the diaphragmatic flutter of belly dancerrsquossyndrome and is a form of myoclonic jerks

Amin OSM et al BMJ Case Reports 2012 doi101136bcr-2012-007393 1

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2 Amin OSM et al BMJ Case Reports 2012 doi101136bcr-2012-007393

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eports first published as 101136bcr-2012-007393 on 24 Decem

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