I had severe heartburn. Could your problem be related to balance?

The response was immediate. This was unlikely to be a reaction to the PPI, her friend wrote. A nutritional deficiency was certainly possible. But the friend would also be worried about a tumor. When was her brother planning to return home? If he was going to stay in Chicago, one of his colleagues there might be willing to see him right away. He didn’t say it, but she felt like she was telling him that she wasn’t exaggerating, that her brother needed to be taken care of immediately. She was vice chair of the neurology department at the University of Cincinnati, just a five-hour drive away. She approached another colleague, Daniel Woo, the neurologist who was admitting patients to the neurological service that night. She explained her brother’s symptoms and he agreed that she should come. Woo would make sure to have an MRI done once he was admitted.

They drove to Cincinnati the next day and did an MRI. Her sister watched the images that appeared on the screen. There, just behind her ear, among the gray swirls of her brain, was a bright white mass, about the size of a golf ball. It was a tumor, one of the largest she had ever seen. The neurosurgeon went to tell the patient what she had found. It was probably an acoustic neuroma, a slow-growing tumor that is not cancerous. The tumor develops from cells that protect and support the nerves that control balance and hearing in the middle ear. For reasons that are not well understood, these cells begin to grow uncontrollably, but slowly. As the tumor grows, it disrupts the nerves and causes unilateral hearing loss, tinnitus (ringing in the ear), and difficulty with balance. It was also the tumor that had caused the nausea and vomiting that had torn his esophagus. Woo explained that although it was not cancerous, it had to be removed or it would continue to grow.

Because the tumor was so large and close to so many important structures, it could not be removed in a single operation. The first surgery, performed three days later, lasted 12 hours. After surgery, the first thing the patient noticed was that the metallic taste that accompanied him daily for months had disappeared. The nausea also disappeared. But so was his hearing in that ear. And his balance was even worse. Along with most of the tumor, the surgeon was forced to remove the nerves responsible for hearing and balance on the right side of his brain. The patient had to relearn to understand where in the world he was using only half of his previous equipment. The second surgery to remove the rest of the tumor was performed six months later.

All this happened four years ago. Recovery was slow. And even now he doesn’t know how to bowl. His balance is better, but not as good as before the tumor. But his brain works in all the other ways he values. And these days he has a lot of other things to think about: he and his wife now have a daughter, just over a year old.

Lisa Sanders, MD, is a contributing writer for the magazine. Her latest book is “Diagnosis: Solving the Most Perplexing Medical Mysteries.” If you have a solved case to share, please write to her at Lisa.Sandersmdnyt@gmail.com.