Mal de desembarque / Mal de debarquement

Resumen El síndrome de mal de desembarque es un cuadro clínico de mareo y oscilaciones corporales persistente, descrito siglos atrás cuando los marineros llegaban a tierra después de navegar. Actualmente, se sabe que este cuadro clínico ocurre también al bajarse de cualquier medio de transporte, ya sea marítimo, aéreo o terrestre. Cuando el cuadro clínico tiene una duración de tres o más días, se denomina mal de desembarque persistente, y se asocia a cefalea y mayores niveles de ansiedad y síntomas depresivos. A continuación, presentamos el cuadro clínico de un paciente que consultó por mareo persistente posterior a un paseo en bote en el mar. Se discute diagnóstico y manejo terapéutico.

Abstract Mal de Debarquement is a clinical syndrome characterized by persistent self-motion dizziness and increased oscillatory body sway, that was described centuries ago after sailors landed in port. Nowadays, it is known that mal de debarquement could appear after any travel in a motion vehicle, including airplanes, ships and cars. When the duration of the symptoms lasts longer than three days, a persistent mal de debarquement is diagnosed, and it is associated with headache and higher levels of anxiety and depressive symptoms. Here, we present a clinical case of a persistent mal de debarquement that attended to the Otolaryngology clinics at the Clinical Hospital of the University of Chile after a boat trip in the sea. We discuss diagnosis and clinical management.

The electrocardiographic response to high +Gz centrifuge training.

The electrocardiographic (ECG) responses of 59 asymptomatic, healthy flight surgeons to the acceleration profiles included in current U.S. Air Force and U.S. Navy high-G centrifuge training programs are documented. ECG dysrhythmias were frequently observed during exposure to both gradual and rapid onset training profiles. Short self-limited episodes of ventricular tachycardia occurred in 5 subjects. Advanced Lown grade ventricular ectopy occurred in 13 subjects. The type of cardiac ectopy and the frequency of occurrence for each of the training profiles is described. The results suggest that significant ectopy frequently occurs during exposure of healthy, asymptomatic individuals to centrifuge training profiles. Since aircrew are expected to undergo high +Gz as part of their usual flying duties, ECG monitoring during high-G centrifuge training has not universally been a required part of the training exposures. Aircrew have not always accepted ECG monitoring during centrifuge training, fearing detection of certain cardiac dysrhythmias, which current aeromedical standards consider disqualifying for continued flying duties without clinical aeromedical evaluation. Based on the results of this study, and previous documentation of the occurrence of significant +Gz-induced cardiac dysrhythmias (both in flight and on the centrifuge), ECG monitoring might be considered appropriate to ensure optimum medical safety during high-G centrifuge training. The current inconsistency between 1) not monitoring ECG because of the aeromedical standards for flying qualification relating to the ECG response to +Gz stress, and 2) the need to monitor ECG to assure optimum safety during centrifuge training, deserves resolution.

Neuropsychiatric observations of proprioceptive sensitivity in motion sickness susceptibility.

The assessment of motion sickness susceptibility is still an unsolved problem, due in part to its unclear etiology. We studied 16 referred patients suffering from "idiopathic motion sickness" and 4 pilots suffering from motion airsickness. All clinical and neurological tests proved negative, including electroencephalograms, electronystagmograms, Doppler studies, and computerized tomography of the brain. Cervical spine X-rays and personality characteristics were assessed. Simultaneously, 35 asymptomatic pilots and pilot applicants were studied as controls. Both groups were exposed to cross-coupled accelerations on a Barany chair at 15 rpm along with 0.5 Hz head flexions. The pathological group showed a straightened cervical curvature as well as a significantly higher degree of malaise (scale of Graybiel and Lackner). Their personalities were highly alexithymic or obsessive compared to the control group (Kruskal-Wallis Test). Alexithymic and obsessive personalities may express their stress reactions and psychic conflicts through somatic signs, such as cervical muscle contractures; consequently, straightening the cervical spine with the subsequent alteration of proprioceptive inputs to the vestibular nuclei may increase motion sickness susceptibility.