This 33-year-old woman was admitted to the psychiatry ward with a combination of abnormal behaviors (“little girl” speech, screaming, and amnesia) and what was referred
as “bizarre” ataxia. She had had intractable vomiting for approximately 3 weeks prior to her admission, reportedly triggered by a remorseful confession to her husband of an extramarital affair. She complained of feeling that “the ground is moving.”

Our patient had a combination of unusual features, which were suggestive of a psychogenic etiology to the admitting physician. Of her symptoms, however, the “moving ground” was the most important because it led to the careful oculomotor characterization, which disclosed upbeat nystagmus. She also had a wide-based gait that in no way showed the “bizarre” features it had been attributed, which justified a delayed neurologic evaluation as outpatient after discharge, preventing prompt diagnosis and initiation of therapy.