Mal de debarquement: Vertigo and dizziness after a cruise

I have a patient with very unusual visual symptoms and sense of imbalance that has persisted for more than a year.  She describes very unusual and concerning symptoms including true diplopia, a sense of major visual disturbances like the floor buckling in her visual fields, vertigo, severe sense of imbalance and swaying, headache, memory fog and concentration difficulty.

Of note is that her symptoms seemed to start after a cruise.  I had no idea what was causing her symptoms, and asked her to see both an ophthalmologist and a neurologist.  Most recently she consulted a neuro-opthalmologist and was given a diagnosis of Mal de debarquement. He did hedge by asking her to also consult a retinal specialist and a vestibular ENT specialist, but he seemed pretty confident of the diagnosis.  I admit I’d never heard of this disorder until she mentioned it. I am glad I’d never had a patient who had symptoms consistent with Mal de debarquement before because it seems a really miserable problem without effective treatment. My wife tells patients to pray that their physician finds their medical history to be uninteresting, never have a condition your doctor will find interesting.  Interesting problems are too often also difficult. This is a perfect example.

Mal de debarquement is a syndrome that usually but not always occurs after an experience of prolonged motion like being on a cruise ship, shorter boating expedition or even an airplane or car ride.  On debarking (debarquement in French) the affected person perceives a sense of movement, unusual visual symptoms, and sometimes cognitive problems like memory loss, difficulty with multi-tasking and trouble with screen situations like using a computer or watching television.

Strangely in many patients these symptoms are reduced when actually in motion like in a car, on a boat or plane.  This seems counterintuitive, but having this phenomenon is a clue to the diagnosis in many patients.  Unlike motion sickness the persons who develop this generally were not sick during motion.  The relatively common condition of “land-sickness” or post motion vertigo is brief, differentiating it from Mal de debarquement which lasts months to years.

The incidence of Mal de debarquement is not known, but it is felt to be either very uncommon or rare, and to be under-diagnosed and under-reported. It seems to be much more common in women with one series published in 1999 in JAMA Otolaryngology Head & Neck Surgery of 27 patients having 26 females.  The mean age of onset is 49 in this same series. There seemed to be little or no relationship to menopausal status. The authers do not feel this is a migrane phenomenon. Although Mal de debarquement is by definition a long-lasting condition it does seem to often improve to some degree with time. No specific treatments have been shown to be effective.  Typical treatments for vertigo like meclazine and scopolamine patches do not seem to help. Benzodiazepines may give some relief.

I hope my patient improves over time if she in fact has Mal de debarquement, and hope this post will increase awareness of this condition in readers.

Edward Pullen is a family physician who blogs at DrPullen.com.

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