FRCS (ORL-HNS) · SECTION 1 SBA

Mal de débarquement syndrome

After a week-long cruise, a patient has persistent rocking and swaying that improves while riding in a car and returns when stationary. Examination and vestibular testing are normal. What is the most likely diagnosis?

CHOOSE ONE ANSWER

Best of five

  1. A. Posterior-canal BPPV
  2. B. Mal de débarquement syndrome
  3. C. Ménière disease
  4. D. Vestibular neuritis
  5. E. Perilymph fistula
ANSWER AND REASONING

B. Mal de débarquement syndrome

Persistent oscillatory self-motion after passive travel, paradoxically relieved by renewed motion, is characteristic. Diagnosis is clinical after excluding structural and vestibular alternatives.

Why every option is right or wrong

A. Posterior-canal BPPV: BPPV causes brief position-triggered spinning with characteristic nystagmus.

B. Mal de débarquement syndrome: Persistent oscillatory self-motion after passive travel, paradoxically relieved by renewed motion, is characteristic. Diagnosis is clinical after excluding structural and vestibular alternatives.

C. Ménière disease: This requires episodic vertigo with fluctuating cochlear symptoms.

D. Vestibular neuritis: That causes a sustained acute vestibular syndrome with unilateral signs.

E. Perilymph fistula: Pressure-triggered vertigo and hearing change would be expected.

What if the scenario changed?

If rocking began without a motion trigger and was worsened by upright posture and visual complexity, persistent postural-perceptual dizziness would be considered.

EDUCATIONAL USE

Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.

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