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Encyclopedia of Canine Veterinary Medical Information
 

Vestibular Syndrome

 There is a syndrome, variously referred to as peripheral vestibular syndrome (the current "preferred name"), geriatric vestibular syndrome and idiopathic vestibular syndrome. This disorder is more common in older dogs and thus the name geriatric vestibular syndrome -- but it can occur in middle aged dogs, too, so the name was changed. Idiopathic just means "happens for no known cause" -- so it is a good name but not the preferred one. It does sum up the situation well, though. For some reason dogs can suddenly develop vestibular disease. The problem seems to be due to inflammation in the nerves connecting the inner ear to the cerebellum (which controls balance and spatial orientation). It usually lasts between a couple of days and three weeks. A few dogs have residual signs beyond this time, such as a head tilt. This disease normally affects dogs that seem normal up until the signs appear. Then there is sudden loss of balance with many dogs unable to even stand up. Rythmic eye motion known as nystagmus is usually present. Dogs may be nauseous from the "sea sickness" effect of vestibular disease. Most dogs will not eat or drink unless hand fed or given water by hand because they have a hard time with the fine motor movements necessary to eat or drink from a bowl. As long as they are nursed through this condition almost all dogs will recover. There is no known treatment. Some dogs do have relapses but most do not.

Peripheral vestibular disease can be confused with anything that will cause cerebellar damage or inner ear disease. Inner ear infections are probably the most common cause of similar symptoms and if recovery does not progress satisfactorily it is a good idea to do whatever testing seems necessary to rule out inner ear problems, such as ear examination and X-rays. Cancer affecting the cerebellum, the peripheral nerves to the cerebellum or the inner ear can cause similar signs. In golden retrievers lymphoma is a common cancer problem that can cause CNS signs. Trauma is a possible problem that could be confused with peripheral vestibular syndrome if brain damage occurs. Granulometous meningoencephalitis (GME). Infarcts (blood clotting leading to lack of circulation in part of the brain) occur in some dogs. If the damage to the brain is minimal then recovery may occur quickly. If the damage is severe, recovery may not occur at all. I do not know the incidence of infarcts affecting the brain in dogs but I think it is pretty low.

Even when dogs do not recover fully from peripheral vestibular syndrome they normally have a good life. They adjust to residual problems like head tilts and do not seem all that bothered by them. If progress towards recovery is not evident, then the other disorders mentioned above need to be considered.

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Vestibular Disease
Vestibular disorder in Golden
Geriatric vestibular syndrome
Peripheral vestibular syndrome in Golden
Peripheral vestibular disorder possible
Vestibular problems
Idiopathic vestibular syndrome
Vestibular disease
Peripheral (geriatric) Vestibular Syndrome

 

also see GME
also see Geriatric Dog
also see Neurological Problems

Older Dogs Can Recover From Vestibular Syndrome
By Dr Pete Keesling

The look on Billie’s face was full of worry as she told me about what had happened to Max. She had just brought her old Siberian Husky into our clinic and was very concerned about him.

Every morning, Max usually liked to go for a short walk around their backyard after she had a cup of coffee. He always insisted that Billie walk with him. He wouldn’t go outside without her.

But today was different. Max hadn’t sat with her as she read the morning newspaper. And when she heard him make some noise, she went to the back door to go out with him. But when she got there, he was in obvious distress, laying down and panting heavily. His head was tilted dramatically to the right side. He couldn’t get up and every time she tried to help him stand, he would fall back over. His sense of balance had abandoned him, and all he could do was involuntarily roll over on his right side.

"He was fine at dinnertime last night. But when I found him this morning, I thought he had had a stroke," she told me. It’s easy to see why she thought so.

I examined Max and within a few moments, determined that he suffered what veterinarians call Peripheral Vestibular Syndrome. Dogs that suffer this syndrome show many of the same symptoms that are associated with a stroke victim. But there are some real differences. What’s more, many of these dogs recover from such an attack and return to their active and happy self.

Vestibular syndrome is usually a rapid-onset attack that causes a head tilt and loss his balance. At first, the symptoms can be very subtle, almost unnoticeable to the owner. But in severe cases, these symptoms can quickly progress to a dramatic and debilitating level such as those that Max suffered. In our clinic, we see at least six or seven cases each year.

Older dogs are more likely to have one of these attacks, but dogs and cats of all ages can be affected. And while there are several theories as to how it occurs, no one really knows the cause. Unlike a stroke, it doesn’t appear to result from a clot obstructing blood flow to the brain.

Some theories claim it is an inflammatory condition near the cranial nerve roots at the base of the brain. Some of these nerves help control balance. Because of this, many veterinarians administer anti-inflammatory medications (such as steroids) to help alleviate any potential inflammation. A clinical exam and some laboratory tests are important to make sure there is no inner ear infection or other condition that might cause similar symptoms. But the bottom line is that we just don’t really know how Vestibular Syndrome originates.

What we do know is that most patients respond very well to aggressive supportive care. Like Max, many cannot stand or even sit up comfortably enough to eat or drink.

They are often distressed, and their owners assume they cannot ever recover. But they really can and most do return to near-normal neurological function.

Routine treatment includes the administration of intravenous fluids and electrolytes. Many veterinarians inject a steroid such as Dexamethasone and maintain the patient on fluid therapy and nutritional support. Some patients have to be hand fed for several days. Good nursing care is essential for those patients that cannot care for themselves. And in every case, a clinical evaluation is done to determine if there is some other problem (such as diabetes, kidney or liver disease) which might make total recovery more difficult.

The good news is that with persistence, patients like Max can overcome this syndrome and go home to be healthy and happy members of the family. For a few, there may be some residual change to the facial features. My family’s English Bulldog, Reggie, recovered from such an attack, but always had a slight sag to his lower left eyelid and left lip. He was otherwise completely normal after a 3 week recovery. And he lived for several more years after his attack.

Max couldn’t sit up for 5 days, and he didn’t stand without help for almost two weeks. But with patience and support from Billie, he went home to resume life as the "boss of the family". I saw him back at the clinic a few months later. His right ear and lower lip were still a little droopy, but his attitude was "vintage Max". He gave me a little lick on the cheek that told me he was okay. Max had recovered. Life was good again.

Dr. Pete Keesling is a practicing Veterinarian with San Martin Veterinary Hospital in California, where his work has included everything from family pets, dogs and cats, to livestock including cows, and horses. In addition he has been an instructor in the Animal Health Technology program at Hartnell College for the past three years. He was a Staff Veterinarian for Pets.com, and is a co-host of a popular weekly television program, called "Petpourri". He was also a contributing writer for a special monthly Q&A column for kids for Disney.com.

Vestibular Disease in Older Dogs

by

--Caroline Coile

 

Vestibular Disease

 
   

 

 The dog's owners thought for sure their dog had suffered a stroke. They thought their dog was going to die. It came on suddenly. Mary, a 14 year-old dog, collapsed on her left side during her daily morning walk. Her owner thought she had stumbled and helped Mary to her feet. After a few minutes they were able to walk the mile home. Mary's owner watched her closely, but everything seemed normal again. Mary took her usual nap, but by afternoon her condition had deteriorated. Mary's eyes twitched rapidly back and forth and when she tried to stand she was unable to keep her balance. She could not stand or walk without tipping over to the left side. She had to be carried outdoors and held to urinate. By evening, she vomited what little she had eaten that day.

Mary's owners carried her into their veterinarian's office the next morning. She still had no balance and her eyes still twitched. Their veterinarian called it old dog vestibular syndrome and prescribed an antibiotic and prednisone. He couldn't be absolutely sure of his diagnosis without further invasive tests and offered no details regarding her prognosis. Time would tell if it was truly old dog vestibular syndrome. Ruling out trauma from a head injury, a number of conditions could cause the same symptoms: a brain tumor, bacterial infection or bleeding from a blood vessel in the brain.

Vestibular means "a problem with the connections between the inner/middle ear and brain" causing ataxia. Dogs with ataxia stand with their limbs braced, they walk with great difficulty and have a "drunk" type motion because the dog has lost its sense of balance and cannot tell where its paws are. When the vestibular nerve, which travels from the inner ear to the brain, malfunctions, it disrupts the animal's sense of balance and orientation.

It is important to find out where the vestibular abnormality is located. The disturbance can be peripheral, meaning it is located outside the brain, or central, located inside the brain. The distinction between the two is subtle and is best diagnosed by a veterinary neurologist. The peripheral vestibular disturbance is the most common and least serious.

It has been suggested that there is a correlation between old dog vestibular syndrome and hypothyroidism so blood work should be done to rule out this problem. The ears should be thoroughly examined because the same symptoms can result from a severe ear mite infestation. Also, certain types of antibiotics such as streptomycin and gentamicin can cause vestibular syndrome.

This syndrome is not a life threatening condition, nor should it even be called old dog vestibular syndrome because young dogs have also contracted it. However, in most cases, old dogs are seen by veterinarians with this condition more often.

Old dog vestibular is not exclusive to dogs. All higher animals that have a vestibular system, from fish to mammals, can be afflicted. With most unilateral peripheral vestibular diseases, the cause is idiopathic, which means no one knows what causes it.

Time is a major factor in old dog vestibular syndrome. Recovery time depends on the afflicted dog. Eventually the animal teaches itself to compensate and overcome old dog vestibular. Rest and quiet are required during this recovery time, and it's important to keep the dog in a well lighted room. If possible, avoid carrying the dog or, if this is unavoidable, lift the dog slowly and smoothly and hold the pads of its feet while airborne. Lifting and moving it through the air disrupts the dog's sense of orientation. Keeping the dog's feet firmly on the ground with its eyes on the horizon helps it regain its balance.

Mary became nearly symptom-free about five months after her episode. She is back to her old routine but is left with a few reminders; her head still tilts slightly, her coordination is not what it was and she avoids dark corners and steep staircases.

This condition is sometimes misdiagnosed and dogs who could have recovered have been euthanized because the condition appears so severe. It is important to note that there are no warning signs which may lead to the conclusion that it is a stroke. Fortunately, most dogs will be spared this affliction. However, if your dog does contract this disease, it is comforting to know that it is not fatal and recovery is merely a matter of patience and tender loving care.

Please note that a serious inner/middle ear infection (which can occur without the customary smelly ear) has the same severe and frightening symptoms. An infection can usually be cured with antibiotics and the dog have a complete recovery. As always, check with your vet.

Dog ear problems: canine peripheral vestibular syndrome


 

Unless your dog has had the bad luck to experience this condition, few people will have heard of Canine Peripheral Vestibular Syndrome, even though the complaint is not uncommon, especially amongst older dogs.

 

The symptoms are dramatic and sudden and are often confused with stroke or poisoning, even by some vets who may have had little experience with the illness. The fact is, Canine peripheral vestibular disease has nothing to do with malfunctions of the brain or a morbid appetite, but is caused by inflammation of the inner ear.

 

Usually there is little sign of any build up to the disease and one of its characteristics is its habit of striking out of the blue. The dog appears perfectly well and happy, eating its meals and taking its usual exercise when for no apparent reason it falls over. When it tries to regain its feet, it staggers in drunken circles, bangs into objects and tumbles down steps.

 

This alarming site is often made more dramatic by the dog vomiting, which once it has emptied its stomach, tends to be a frothy yellow colour. If you take a closer look you will notice that the eyes shoot rapidly from side to side, the head is cocked to one side and these, together with the drunken staggers and vomiting lead many owners to the fearful conclusion that their pet has been poisoned. Alternatively, when no evidence of any toxic substance can be found, they consider the possibility of stroke.

 

 

 

Neither poisoning or stroke is the cause of this condition, but the inner ear. Examination by a vet may reveal some kind of infection, but usually there is nothing to see within the ear itself and the cause of the onset of the disease usually remains unknown.

 

What is thought to happen is that the nerves of the inner ear connecting to the cerebellum, which controls balance and spatial orientation become inflamed causing the distressing symptoms previously described, but why this should happen is as yet unclear. There seems to be a link to age as the disease is much more common in old dogs, though younger animals that are around the middle age mark can be affected too.

 

Symptoms vary in their severity, not all dogs experiencing the same degree of vomiting and unbalanced co-ordination and this seems to correspond to the duration of the illness. Symptoms usually last between three days and three weeks, but the good news is, almost all dogs make a good recovery, although some my be left with a slight tilt of the head.

 

Relapses can occur, but are not common. Dogs of a more advanced age that were previously fit and healthy tend to suddenly show their age by refusing to take as much exercise as they used to and sometimes there will be a noticeable decline in eye sight and hearing. Whether this is due to the vestibular disease or is just part of the aging process is difficult to say, but many owners do comment on the decline of their pets senses after recovering from the disease.

 

There is no medical treatment for the condition, although some vets may prescribe antibiotics if they suspect the possibility of infection. What the owner needs to do is provide good nursing and plenty of tender loving care, since the dog is usually very confused and sorry for itself.

 

Alarming as the symptoms are for the owner, they are terrifying for the dog who doesn’t understand why the world has suddenly started spinning in such a crazy fashion. Usually it seeks the sanctity of its bed and refuses all food and drink. Any attempt to stand or walk precipitates vomiting.

 

Hand feeding with water and easily nibbled food is the order of the day, although don’t be surprised, if your dog is severely effected, it doesn’t eat for a week. It is also appreciated by the invalid if you offer some support when it does begin to venture back on its feet.

 

The few dogs that do not quite make a full recovery quickly learn to cope with the head tilt and any unsteadiness and are able to enjoy a quality life which should last to its allotted span.

 

These five tips should help you to spot vestibular disease, but always get your pet checked by a qualified vet at the onset as there can be other more serious reasons for the symptoms.

 

1. Dog is perfectly well then begins to stagger and fall about.

2. Dog vomits.

3. Eyes shoot from side to side in a rhythmic action.

4. Head is tilted to one side.

5. Refuses food and or water

 

If any of these symptoms persist beyond the three week mark then the chances are that this is not Canine Vestibular Syndrome. Other afflictions such as cancer, brain tumors, and inner ear infections can all produce similar symptoms but do not fade with time.



 

Written by Sue Kendrick

For Dogs with Vestibular Syndrome

Here's an excellent suggestion from a website visitor (Parkosew@gateway.net): "I wanted to share with your readers a suggestion to aid the mobility of a dog with idiopathic vestibular syndrome. My dog is currently recovering from this distressing syndome, and the vet tech at the pet emergency clinic suggested something that has made our lives a lot easier. She told me to get a seat-belt-type harness found at most pet stores. This fits under the chest and has a nylon loop centered over the top of the dog's back, making it very easy to support and stabilize the dog during stair climbing or walking. The long loop makes the harness easy to hold onto and eliminates excessive bending."