Motorist Disorientation Syndrome: A Retrospective Longitudinal Case Series of Driving- Related Spatial Disorientation

Background Motorist disorientation syndrome (MDS) is a rare and under-recognised condition characterised by dizziness, spatial disorientation, and disturbed perception of vehicle motion during driving. Its clinical boundaries, comorbidities, ancillary findings, and management remain insufficiently defined. Methods We performed a retrospective longitudinal case series of five patients evaluated for MDS at a tertiary neuro-otological and neurological centre between June 2024 and June 2026. Clinical records were reviewed for symptom profile, 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 primary MDS, whereas three had secondary or associated MDS following benign paroxysmal positional vertigo, persistent postural-perceptual dizziness (PPPD), and PPPD secondary to vestibular neuritis. Symptoms were provoked by specific driving situations, including 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 a reduction in symptom burden at 3-month follow-up, although residual symptoms persisted in some cases; given the absence of a comparison group, this improvement may partly reflect regression to the mean rather than a specific treatment effect. Conclusion MDS is a heterogeneous, driving-specific disorder that appears to benefit from careful diagnostic evaluation and individually tailored multimodal management, although larger controlled studies are needed to confirm these observations.