There were no hand cymbals or sequined harem pants, and no Middle Eastern music was playing in the background. And yet the rhythmic, wavy movements of an Iraqi woman's abdominal wall muscles resembled belly dancing.
Although her midsection lacked Shakira's graceful shimmying, its unintentional "jerky" movements were from a rarely diagnosed neurological condition known as "belly dancer's syndrome."
In an intriguing case study and video published in the British Medical Journal's Case Report, doctors describe and show the visible vibrations of this woman's stomach, most noticeable on her left side.
Belly dancer's syndrome is a form of myoclonic jerk, which in its more common forms can trigger hiccups or can cause the sudden muscle twitches known as "sleep starts" before nodding off. Like hiccups, belly dancer's syndrome affects the diaphragm, the main muscle involved in breathing.
The fluttering motion seen in the woman's stomach occurred because her diaphragm was rapidly contracting and releasing. When this muscle's contraction and relaxation cycle is disorganized, normal breathing is interrupted, says study author Dr. Osama Amin, a neurologist at Sulaimaniya General Teaching Hospital in Sulaimaniya City, Iraq.
As a result, she felt short of breath since she couldn't exhale fully. And these quick diaphragmatic contractions were also causing her a great deal of abdominal pain, like the pain brought on by a muscle spasm, explains Amin, who is a fellow of the American College of Physicians.
According to the case report, a week before this 47-year-old Iraqi Kurdish woman showed up at the emergency room, she had an operation to remove hemorrhoids. She was feeling fine two days after her surgery and was sent home from the hospital. But four days later she noticed the undulating movements of her belly.
At first, her doctors thought she may have an intestinal obstruction. But when she was given treatment for this condition, her symptoms did not improve. So they asked Dr. Amin, a neurologist, to see this patient thinking she may have had a seizure.
"We did a thorough search for any underlying cause within the abdomen, brain, and spinal cord but it was fruitless," says Amin. Nothing turned up either when they did blood tests on her, meaning that this mother of four was otherwise healthy.
This led Amin to conclude that the cause of her belly dancer's syndrome was psychological in origin and was possibly triggered by the stress of her recent surgery. Interestingly, the abdominal wall fluttering would stop while the woman was sleeping and would start up again when she was awake, another indication that its roots were psychological.
Once diagnosed, Amin prescribed two medications -- an IV form of Benadryl and the muscle relaxant Valium -- to help get rid of her belly dancing movements. After three days on this drug treatment, all of her symptoms disappeared and they have never returned.
So how did this woman, who had never belly danced in her life, react to hearing she had "belly dancer's syndrome," a funny name for a rare condition?
"She laughed," says Amin. "But we immediately reassured her that this is just a name; it's not a bad stigma, and her diagnosis is 'frequent spasms of the diaphragm.'"