Clinical case · clinician

Litigated whiplash with inconsistent findings

Vignette

A 38-year-old man is referred for vestibular assessment as part of a litigation for a low-impact rear-end motor vehicle collision 18 months ago. He reports severe constant dizziness preventing him from working but is observed by clinic staff to walk steadily across the car park. Caloric and head impulse testing are within normal limits, as is MRI. On CDP, he repeatedly stumbles on conditions 1, 2, and 4 but maintains stable stance on conditions 5 and 6. Trial-to-trial variability is conspicuous.

CDP findings

SOT pattern vs normal
Aphysiologicage norm 700255075100EQS52C1EO ·F50C2EC ·F56C3EO ·F·Sw33C4EO ·Sw67C5EC ·Sw55C6EO ·Sw·Sw
MCT — medium-amplitude backward translation
platform135 ms-100-500+50+100COP mm0200400600800100012001400Aphysiologic · backward · medium
ADT — sway energy across five trials per direction
sway energy025507510067T160T269T358T465T5Toes upno adaptation66T183T261T368T464T5Toes downno adaptation

Single-best-answer

How should the CDP findings be reported?

Teaching point. The Cevette (1995) aphysiologic criteria identify patterns where performance on easier SOT conditions (C1–C4) is paradoxically worse than on harder C5/C6, often with high intertrial variability. The pattern raises the question of functional or feigned disease but is non-specific. Medico-legal reporting must acknowledge this non-specificity.

References