Vestibular Disease

This is a relatively sudden onset, extreme looking condition which usually affects older dogs, but can also affect cats.

The disease is not uncommon, often being called ‘Old Dog Vestibular Syndrome’, or an ‘Old Dog Stroke’.

The vestibular system is the collective term for all the parts of the ear and brain that control balance. This includes the semi-circular canals in the inner ear, the brain (cerebellum and brain stem), and the nerve connecting these two (Cranial Nerve VIII, or the Vestibular nerve).

As the fault is with the balance system, the result in the animal is quite dramatic, and unless you know what is happening, it can be very frightening!

Disruptions to the vestibular system in humans result in dizziness and vertigo, which is what it must feel like for our animals. It is not a painful condition, just very disorientating.
Signs include:

• A head tilt
• Loss of balance, falling, rolling or compulsive circling to one side (known as ataxia)
• Repeated abnormal eye movements (known as nystagmus, the eyes will drift in one direction before quickly re-centring)
• Vomiting, nausea
• Disorientation

The cause of this disease is unknown 90% of the time (termed Idiopathic Vestibular Disease). It can occasionally be due to an inner ear infection (otitis interna), and rarely can be due to other causes such as head trauma, infections, antibiotic toxicity or neoplasia. Very rarely do we see dogs that have suffered a true cerebrovascular ‘stroke’ as we experience in humans.

The good news is that the prognosis is generally incredibly good! The vast majority of animals go on to make a full recovery.

In most cases the treatment is supportive; intravenous fluids, anti-inflammatory and anti-sickness medications, along with dedicated nursing to help the animal go out to the toilet, eat and stay calm and comfortable. If an internal ear infection is suspected, antibiotics will also be given.

The length of time it takes each animal to recover is variable. The nystagmus and vomiting usually settle within 72 hours of onset, and most animals regain some ability to stand and walk, even if they are a little wobbly. At this stage, we are normally happy for the animal to go home, as long as they can be kept calm and well supported. It can take 2 weeks for signs to fully resolve. Some animals are left with a slight permanent head tilt, but this mostly has no effect on their balance. Some animals do suffer with a relapse within the next year, which can be treated the same, but your vet may recommend a more detailed investigation to search for any potential causes.