Visual Vertigo, Motion Sickness and Disorientation in vehicles

The normal vestibular system may be adversely affected by environmental challenges which have characteristics that are unfamiliar or ambiguous in the patterns of sensory stimulation they provide. A disordered vestibular system lends susceptibility even to quotidian environmental experiences as the sufferer becomes dependent on potentially misleading, non-vestibular sensory stimuli. In both cases the sequela may be dizziness, incoordination, imbalance and unpleasant autonomic responses. Many forms of visual environmental motion, particularly busy places such as supermarkets, readily induce inappropriate sensations of sway or motion and imbalance referred to as visual vertigo. All people with intact vestibular function can become motion sick although individual susceptibility varies widely and is partially determined by inheritance. Motorists learn to interpret sensory stimuli in the context of the car stabilised by its suspension and guided by steering. A type of motorist disorientation occurs in some individuals that develop a heightened awareness of false perceptions of car orientation, readily experiencing stereotypical symptoms of threatened rolling over on corners and veering on open highways or in streaming traffic. This article discusses the putative mechanisms, consequences and approach to managing patients with visual vertigo, motion sickness and motorist disorientation syndrome in the context of chronic dizziness and motion sensitivity