ABSTRACT
The neurologist, having decided upon the localization and probable etiology, explains to Ernesto the nature of his illness and the likely diagnosis, as well as the next steps that need to taken. It is due to a combination of age-related degeneration in the somatosensory, visual and vestibular systems and their central integration and highlights the multisensory nature of human balance. The onset of cranial nerve deficits in Lyme disease is typically considerably more rapid than we have seen in Ernesto's story; nevertheless, in endemic regions, this diagnosis would have to be considered and excluded by specific testing. The neurologist explains the diagnosis of vestibular schwannoma as the most likely cause of Ernesto's problems and the likelihood of requiring neurosurgery. It is now eight to nine months since the onset of symptoms and three to four months since Ernesto first saw his family physician.
