Contributors: Laurent Garosi
Species: Canine | Classification: Diseases
Introduction Pathogenesis Diagnosis Treatment Outcomes Further Reading
Introduction
- Most frequent peripheral vestibular syndrome in older dogs.
- Signs: acute onset of severe vestibular signs.
- Diagnosis: negative findings on investigations for other vestibular diseases.
- Treatment: none.
- Prognosis: good.
Follow the diagnostic tree for Vestibular disease.
Presenting Signs
- Vestibular signs:
- Head tilt.
- Ataxia Ataxia.
- Nystagmus.
- Falling, rolling, leaning to one side.
Geographic Incidence
- Worldwide.
Age Predisposition
- Older dogs.
Breed Predisposition
- Any breed.
Cost Considerations
- If X-ray, CT or MRI performed.
Pathogenesis
Etiology
- Unknown.
Predisposing Factors
General
- Age.
Pathophysiology
- Idiopathic.
Timecourse
- Acute onset.
- Stabilizes in a few days.
- Gradual improvement in a few weeks.
Diagnosis
Presenting Problems
- Gait abnormalities.
- Head tilt.
- Nystagmus.
- Falling, rolling, leaning to one side.
Client History
- Acute onset of severe vestibular signs.
- Older dog.
Clinical Signs
- Head tilt.
- Falling, rolling, leaning to one side.
- Wide base stance.
- Ataxia with normal postural reactions.
- Pathological nystagmus , usually horizontal or rotatory and not altered with position of the head.
Diagnostic Investigation
Radiography
- No findings.
- Otoscopy:
- No findings.
Definitive diagnostic features
- Diagnosis by exclusion of other causes of acute peripheral vestibular syndrome.
Histopathology Findings
- No lesions found.
Differential Diagnosis
- Otitis media Otitis media.
- Otitis interna Otitis interna.
- Neoplasia in the region of the bulla.
- Trauma Trauma: overview.
- Toxicity, eg aminoglycoside antibiotics - streptomycin Streptomycin , gentamicin Gentamicin , topical ionophors or chlorhexidine Chlorhexidine.
- Vascular accident ('stroke') Cerebrovascular disease.
- Hypothyroidism Hypothyroidism.
Treatment
Initial Symptomatic Treatment
- No specific treatment has proven beneficial.
- Meclizine (12.5 mg PO q12h), diazepam (0.1-0.5 mg/kg PO q8h) Diazepam and/or maropitant (1 mg/kg SC q24h or 2 mg/kg PO q24h) Maropitant citrate are sometimes helpful in decreasing signs associated with acute vestibular disturbance (nausea, anorexia, anxiety and, in some instances, the severity of head tilt and ataxia).
Outcomes
Prognosis
- Good: most dogs recover without treatment, though a head-tilt may persist.
- May recur within a period of weeks to months.
- Some animals may be left with episodic ataxia or a persistent head tilt.
Expected Response to Treatment
Reasons for Treatment Failure
Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Rossmeisl Jr J H (2010) Vestibular disease in dogs and cats. Vet Clin North Am Small Anim Pract 40 (1), 81-100 PubMed.
- Thomas W B (2000) Vestibular dysfunction. Vet Clin North Am Small Anim Pract 30 (1), 227-249 PubMed.
Other sources of information
- de Lahunta A, Glass E (2009)Vestibular system - special proprioception.Veterinary Neuroanataomy and Clinical Neurology. 3rd edn. W B Saunders, Elsevier, St Louis, Missouri. pp 319-347.
- Munana K R (2004)Head tilt and nystagmus.In:BSAVA Manual of Canine and Feline Neurology. 3ed edn. S R Platt & Olby N J (eds). pp 155-171.
- Bagley R S (2000)Vestibular disease of dogs and cats.In:Current Veterinary Therapy XII.Ed: R W Kirk. Philadelphia: W B Saunders. pp 966-971.
Further Reading
- The Webinar Vet - Understanding Vestibular Syndrome