Psychological symptoms and spatial orientation during the first 3 months after acute unilateral vestibular lesion

We undertook this study to assess the correlation between the results of simple tests of spatial orientation and the occurrence of common psychological symptoms during the first 3 months after an acute, unilateral, peripheral, vestibular lesion.

Ten vestibular patients were selected and accepted to participate in the study. During a 3-month follow-up, we recorded the static visual vertical (VV), the estimation error of reorientation in the yaw plane and the responses to a standardized questionnaire of balance symptoms, the Dizziness Handicap Inventory (DHI), the depersonalization/derealization inventory by Cox and Swinson (DD), the Dissociative Experiences Scale (DES), the 12-item General Health Questionnaire (GHQ-12), the Zung Instrument for Anxiety Disorders and the Hamilton Depression Rating Scale.

At week 1, all patients showed a VV >2° and failed to reorient themselves effectively. They reported several balance symptoms and handicap as well as DD symptoms, including attention/concentration difficulties; 80% of the patients had a Hamilton score ≥8. At this time the balance symptom score correlated with the DHI. After 3 months, all scores decreased. Multiple regression analysis of the differences from baseline showed that the DD score difference was related to the difference on the balance score, the reorientation error and the DHI score (p <0.01). No other linear relationships were observed (p >0.5).

During the acute phase of a unilateral, peripheral, vestibular lesion, patients may show poor spatial orientation concurrent with DD symptoms including attention/concentration difficulties, and somatic depression symptoms. After vestibular rehabilitation, DD symptoms decrease as the spatial orientation improves, even if somatic symptoms of depression persist.