After other conditions have been ruled out, A tentative diagnosis of SSS can usually be made, based on symptoms/ history, plus a provocative test or two. This is especially true when the symptoms have remained fairly stable over a number of years. It is sometimes easier for the patient to self-diagnois after reading the long list of symptoms, than it is for the inexperience doctor. However, when sudden or adult onset and/or head trauma is involved, extra care must be taken, including a thorough medical team evaluation approach.
Answers to the following key questions can assist in the diagnosis of SSS.
1. CAN YOU READ IN A CAR WITHOUT NAUSEA, HEADACHE, OR DIZZINESS?
• If the answer is YES, even if you can only read for a few minutes, you need go no further. You do NOT have SSS or typical motion sickness. Doctors – This is a key rule-it out question to routinely ask every patient.
• If the answer is NO, or if you can read only for a few seconds, or can’t even look down in a car, proceed to question 2.
2. DO YOU BECOME NAUSEATED ,OR GET HEADACHES, OR DIZZY WHEN RIDING IN THE BACK SEAT OF A CAR ON A STRAIGHT ROAD?
• If the answer is “NO”, ask no more questions. You do NOT have SSS.
• The above specific words are used instead of asking, “Do you ever get car
sick?” Many patients consciously or unconsciously avoid carsickness
by only looking straight ahead and thus don’t get carsick. Some become fatigued (one of the signs of motions sickness) and go to sleep.
Also, if there is a carsickness problem, carsickness at night is rare because there is less motion seen on sides of the road and passengers tend to look straight down the headlight illuminated road, thus, less observed visual motion and eye movement.
• If the answer is Yes, go on to question 3.
3. CAN YOU SIT CLOSE TO A MOVIE SCREEN, WATCH A SCROLLING COMPUTER, SMART PHONE OR TABLET SCREEN, READ FOR A WHILE OR WATCH A TRAIN GO BY WITHOUT NAUSEA, HEADACHE, OR DIZZINESS OR FATIGUE?
• If the answer is NO, but the answers to questions 1 and 2 were yes, the you might have at least a moderate degree of visually induced motion sickness, but not necessarily SSS. Those considered to have SSS symptoms must also have developed photophobia.
4. ARE YOU SUPER-SENSITIVE TO LIGHT? DO STORE LIGHTS SEEM TOO BRIGHT? DO YOU HAVE TO WEAR SUNGLASSES EVEN ON CLOUDY DAYS?
• If you have gotten this far and answers to all of these questions are yes, you can probably make a tentative diagnosis of SSS. Additional questions to which most patients with SSS will answer yes:
5. DO YOU HAVE FREQUENT, SOMETIMES DAILY HEADACHES OR “PRESSURE” IN YOUR HEAD?
6. DO YOU HAVE NAUSEA, HEADACHES, DIZZINESS OR A SPACEY FEELING WHEN SHOPPING OR MOVING THROUGH CROWDS OF PEOPLE?
7. DO YOU HAVE AN UNUSUAL FEAR OF HEIGHTS?
8. DO YOU FEEL AS IF THERE IS SOMETHING CONSTANTLY IN MOTION INSIDE OF YOU?
9. ARE YOU KLUTZY? DO YOU LOSE YOUR PLACE EASILY WHEN READING?
10. DOES ANYONE IN YOUR FAMILY SHARE THESE SAME SYMPTOMS AS YOU?
Simple provocative Testing can confirm a diagnosis of SSS In many cases. Their familiar primary symptoms of SSS can be reproduced within ten to twenty seconds by exposing the patient to visual motion such as watching a suspended ball swing at arms length, making rapid saccadic (side to side) eye movements with the head still, or simply rolling the eyes around.
Some patients will develop these symptoms during the regular eye exam as well. A few SSS patients are delayed reactors and do not develop symptoms until up to one or more hours after exposure to motion. This reaction to “eye movement only” activity can serve as a positive demonstration to the patient and reassuring to the doctor the eyes are the primary factor contributing to the SSS symptoms.
Click on the this Comprehensive SSS video (iTunes) to view the above procedures and more.