Clinical Features of Driving-Induced Spatial Disorientation: a Retrospective Longitudinal Case Series

Background Driving-induced spatial disorientation is a rare and under-recognised clinical presentation characterised by dizziness, spatial disorientation, and disturbed perception of vehicle motion during driving. Its clinical boundaries, comorbidities, diagnostic findings, and management remain insufficiently defined. This study aimed to characterise its clinical presentation, associated conditions, management, and short-term outcomes. Methods We performed a retrospective longitudinal case series of five patients evaluated at a tertiary neuro-otological and neurological centre between June 2024 and June 2026. Clinical records were reviewed for symptoms, provoking situations, comorbidities, examination findings, ancillary tests, treatment, and 3-month outcomes. Results The cohort comprised three men and two women, with a mean age of 39.4 ± 10.4 years. Two patients had no identifiable precipitating disorder, whereas three developed symptoms in association with benign paroxysmal positional vertigo, persistent postural-perceptual dizziness, or persistent postural-perceptual dizziness following vestibular neuritis. Symptoms were provoked by higher speeds, bends, multilane roads, bridges, overtaking, tunnels, and nearby moving vehicles. Comorbidities included migraine, motion sickness, anxiety-related symptoms, panic attacks, tetany, acrophobia, and ophthalmological disorders. Vestibular and ocular motor testing was largely normal or non-specific. Management was individualised and multimodal. All patients showed reduced symptom burden at 3-month follow-up, although residual symptoms persisted. Without a comparison group, improvement cannot be attributed to a specific intervention and may partly reflect regression to the mean. Conclusion Driving-induced spatial disorientation is a heterogeneous, situation-specific clinical presentation requiring assessment for associated vestibular, neurological, ophthalmological, and psychiatric conditions. Individually tailored multimodal management may be beneficial, although larger prospective controlled studies are required.