Vestibular Disease in Dogs and Cats (2023)

What on Earth is the Vestibular Apparatus?

In a nutshell, the vestibular apparatus is the neurological equipment responsible for perceiving your body's orientation relative to the earth (determining if you are upside down, standing up straight, falling etc.), which inform your eyes and extremities how they should move accordingly.

The vestibular apparatus allows us to walk, even run, on uneven ground without falling, helps us know when we need to right ourselves, and allows our eyes to follow moving objects without becoming dizzy. If you think about it for a minute, it is pretty amazing that any of this is possible so we will take a moment to explain how it works but if you feel you pretty much have the concept,feel free to move on to the next section. The short version is that the vestibular system consists of the structures of the middle ear, the nerves that carry their messages to the brain/central nervous system, and the brain/central nervous system itself.

What's in the Middle Ear?

There are two sets of receptors involved: one to detect rotational acceleration (tumbling or turning) and one to detect linear acceleration and gravity (falling and letting us know which direction is up and which is down). Both receptors are located in the middle ear.

Vestibular Disease in Dogs and Cats (1)

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(Video) What is Vestibular Disease?

Rotation is detected using the three semicircular canals as shown above. These canals contain fluid called endolymph, which moves as the head rotates. Tiny neurological hair cells project into this fluid and are stimulated by the flow. These hair cells are part of sensory nerves that carry the appropriate message to the cerebellum (part of the brain that coordinates walking, running and any other locomotion) and to four vestibular nuclei in the brain stem.

Up and down orientation stems from small weighted bodies called otoliths, which are located within the utricle and saccule of the middle ear. These small otoliths move with gravity within afluidy gel, stimulating small hair cells as they move similar to the situation described above.

From these centers, instructions are carried by nerve cells to the legs, neck, and eye muscles so that we may orient ourselves immediately. The information about being upside down (or in some other abnormal orientation) is also sent to the hypothalamus (an area of the brain) so that we can become consciously aware of our position. The information is also sent to the reticular formation (another area of the brain - a sort of a volume control on our state of wakefulness. In this way, if we are asleep and start to fall, the vestibular stimulations would wake us up. This is also why rolling an anesthetized animal from side to side is used to hasten anesthetic recovery).

Vestibular Disease in Dogs and Cats (2)

Nystagmus is a back and forth or rotational eye movement. Graphic by MarVistaVet

The Signs of Vestibular Disease

If there is trouble in the vestibular apparatus, then you may not properly perceive your orientation. To put it more simply, you won't know which way is up, whether or not you are standing up straight or slanted, and you'll feel dizzy.

(Video) Veterinarian Explains - Vestibular Disease

The following are signs of vestibular disease:

  • Ataxia (lack of coordination without weakness or involuntary spasms - in other words, stumbling and staggering around).
  • Motion sickness.
  • Nystagmus (back and forth or rotational eye movements - The movements will be slower in one direction. This is the side where the neurologic problem is likely to be; however, nystagmus is named according to the direction of the fast component - i.e. thepatientmay have"left nystagmus" but the problem is probably on the right side of the vestibular apparatus.)

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Milou, a dog with vestibular disease, demonstrates a head tilt. At the time of this picture, Milou was not able to walk, but was nearly normal within 4 days. Courtesy MarVistaVet

  • Trouble with other nerves controlling the head and face.

A Word about "Stroke"

Vestibular signs are commonly (and usually incorrectly) referred to as a stroke. While avascular accidentis a possible cause of vestibular signs, it is a rare cause. Vascular disease, while common in people, is unusual in pets.

Causes of Vestibular Disease

In order to determine prognosis and choose treatment, one needs to figure out what has happened to the vestibular system. The first step is to determine whether the lesion is central - in the brain - or peripheral (in the inner ear).

(Video) Signs of Vestibular Disease in Dogs

Idiopathic Disease (Unknown Origin)

Idiopathic vestibular disease is the most common form of vestibular disease in dogs and cats.For unknown reasons, cats are most commonly affected in the northeast U.S. in the late summer and early fall.

Canine idiopathic vestibular disease (also called old dog vestibular disease) and its feline counterpart, feline idiopathic vestibular disease, begin acutely and resolve acutely. Usually improvement is evident in 72 hours and the animal is normal in 7 to 14 days, although occasionally a head tilt will persist. When a case of vestibular disease begins, it may be a good idea to wait a few days to see if improvement occurs before doing diagnostics beyond a routine blood/urine database. These two conditions are idiopathic, meaning we do not know why they occur. We do know that they represent problems in the periphery (nerves of the middle ear rather than in the brain.)

Treatment of idiopathic vestibular disease generally involves control of nausea (motions sickness) while the condition runs its relatively short course.

Brain, the Central Lesion

Vestibular Disease in Dogs and Cats (4)

Dog having a CT scan. (Photo courtesy of Justin M. Goggin, DVM, Diplomate American College of Vet. RadiologyVet MRI and RT Center of NJ)

(Video) Old Dog Vestibular Disease | With Videos

There will be some hints in the clinical presentation that the patient in question has a brain lesion causing the vestibular signs. For example, if other cranial nerves are involved and they are on the side opposite from the head tilt, then the lesion is likely to be in the cerebellum (central). If the nystagmus is vertical (the eyes are moving up and down rather than back and forth) or only exists when the animal is placed in certain positions, then the lesion is more likely to be central.

If the vestibular signs have a central origin, there could be a tumor, vascular accident, infection (especially Rocky Mountain spotted fever) or other lesion in the brain. Imaging of the brain will be important in determining the nature of the lesion and what treatment makes the most sense. This means a CT scan or MRI to image the brain; most likely a referral will be needed for this type of procedure. General anesthesia is required for CT and MRI.

Middle Ear Infection

Middle ear infection is a likely possibility for vestibular disease especially if the patient has a history of ear infections. Concurrent facial nerve paralysis, creating a slackened look to one side of the face, or Horner’s syndrome where there are some eye changes, often go together with middle ear infection.

When an otoscope is used to visualize the external ear of an animal with vestibular disease and debris is seen, this would be a good hint that there is infection in the middle ear as well. However, just because debris is not seen in the external ear does not mean that a middle ear infection is unlikely. Imaging of the middle ear bones may be in order.

The most accessible way to evaluate the middle ear is with a set of radiographs called a bulla series (so named because it focuses on an ear bone called the tympanic bulla). If the bulla appears abnormal, the ear may require surgical drainage. The problem is that radiography is often not sensitive enough to pick up damage in the middle ear and a normal set of films does not rule out disease. In these cases, imaging such as a CT scan or MRI is better, although rather expensive. These imaging techniques, however, allow imaging of the brain tissue itself (which radiology does not), thus allowing brain abnormalities to be evaluated as well.

If the pet has a middle ear infection, a routine cleaning of the external ear can lead to a flare up of vestibular symptoms. This is often unavoidable in long-standing ear infections as there is no simple way to know if an external ear infection extends into the middle ear.

Treating a known middle ear infection can be difficult. Culture of the middle ear may be necessary and oral antibiotics are needed for 6 to 8 weeks to clear the infection from the tiny bones of the middle ear.Surgery may be needed to open the tympanic bullae and flush them out.

FAQs

What triggers vestibular balance disorders in dogs? ›

Causes of vestibular disease include an ear infection, perforated eardrum, hypothyroidism, trauma, tumors or possibly as a side effect of antibiotics. When no specific cause is found, the condition is called idiopathic vestibular disease.

Is vestibular disease fatal in dogs? ›

Symptoms of vestibular disease may look distressing but try to keep in mind that this condition is not fatal, and most dogs completely recover within two to three weeks.

Can vestibular disease be cured in dogs? ›

While vestibular disease may cause your dog some mild discomfort, motion sickness and a lack of coordination, the good news is that the condition it isn't painful or dangerous and will likely clear-up on its own without treatment within a few weeks.

How many times can a dog get vestibular disease? ›

Vestibular syndrome usually occurs only once in any dog's life. However, I have known several dogs who went through the syndrome three or more times. Amy, despite the recurrence of symptoms, I am still betting that your dog does not have any problem other than CVS.

How long do vestibular disorders last? ›

Vestibular neuritis is a self-limiting disease with vestibular symptoms lasting for one to two days, followed by a gradual reduction in symptoms. Rarely does the illness lasts more than several days to a few weeks. Early improvement in symptoms is believed mainly due to central compensation.

Should you euthanize a dog with vestibular disease? ›

While most dogs will recover rapidly from an episode of vestibular disease, signs may persist and recurrence of vestibular disease may also occur. Unfortunately, there is no effective way to prevent the recurrence of idiopathic vestibular disease. In most cases, euthanasia is unnecessary for vestibular disease.

Can Benadryl help vestibular disease in dogs? ›

In addition to helping manage allergic reactions and symptoms, Benadryl also decreases anxiety and anorexia in dogs. Besides this, Benadryl will reduce the severity of head tilts in dogs with vestibular disease. It also helps calm your dog. In addition, the medicine is generally safe.

Can vestibular disease be cured? ›

There's no cure, but you may be able to manage symptoms with medications and vestibular rehabilitation.

What medication is given to dogs with vestibular disease? ›

1 Anti-vertigo medications like meclizine are often prescribed along with anti-nausea drugs. The treatment is similar if the cause of the vestibular dysfunction was a stroke or vascular accident.

Does vestibular disease in dogs affect vision? ›

Similarly, diseases affecting the balance centre in the brain can also affect other parts of the brain causing seizures, weakness, loss of vision, or difficulty eating and drinking.

Does vestibular disease in dogs cause shaking? ›

Many dogs with vestibular syndrome may have no typical signs of ear inflammation such as head shaking, scratching of the ear, inflamed ear canal or inflamed eardrum.

How effective is gabapentin for dogs? ›

There are conflicting clinical reports about its efficacy when used for this purpose, although some studies report improvement in as many as 50% of dogs studied. In dogs, oral Gabapentin is well absorbed in the duodenum, with peak levels occurring approximately one to two hours after administration.

Can a dog relapse from vestibular disease? ›

While idiopathic vestibular disease can recur in dogs after initial improvement, it is less common than with strokes and the interval between episodes is typically longer with idiopathic vestibular disease (months or more) versus strokes (days to weeks or more).

Does vestibular disease come back? ›

Most cases of idiopathic vestibular syndrome improve within several hours to a few days but could take days to weeks to completely resolve. This syndrome can occur again at some point in your pet's life, however it cannot be predicted.

What are 2 symptoms of vestibular problems? ›

What are the symptoms of vestibular balance disorders?
  • Dizziness.
  • Feeling off-balance.
  • Feeling as if you are floating or as if the world is spinning.
  • Blurred vision.
  • Disorientation.
  • Falling or stumbling.

Is vestibular damage permanent? ›

Viral infections (labyrinthitis and vestibular neuritis), disorders that affect inner ear fluid levels (Ménière's disease and secondary endolymphatic hydrops), trauma from head injury, benign tumors (acoustic neuromas), and age-related degeneration can all cause permanent damage to it.

Can anxiety cause vestibular problems? ›

Stress and anxiety can contribute to dysfunction of your vestibular system. Dizziness or vertigo can occur if any part of this system is impaired.

Does vestibular disease in dogs cause deafness? ›

A head tilt, circling, incoordination and nystagmus (a characteristically vestibular lateral eye movement) are all common symptoms. Luckily, most of these symptoms improve with age but will never completely resolve. Deafness is the final blow to these affected dogs.

Is vestibular disease the same as a stroke? ›

Old Dog Vestibular Syndrome, a.k.a. idiopathic vestibular disease is not the same thing as a stroke. It is unknown what causes Old Dog Vestibular Syndrome. It is likely to be due to an age related change in the inner ear. The syndrome mainly affects older dogs resulting in sudden instability, circling and head tilt.

Can I give my dog Dramamine for vestibular disease? ›

What is dimenhydrinate? Dimenhydrinate (brand names: Dramamine®, Gravol®, Travtabs®, Driminate®, Triptone®) is an antihistamine used to prevent motion sickness and to treat nausea, especially in dogs with vestibular disease.

How much Benadryl should I give my dog? ›

Benadryl dosage for dogs.

According to the Merck Veterinary Manual, the safe dosage is 2-4 milligrams of medication per kilogram of weight, or 0.9 to 1.8 milligrams per pound. This amount can be administered two to three times daily, depending on your dog's symptoms.

Can vestibular disease cause death? ›

In addition to controlling head and body position and therefore balance, the brain also controls level of awareness, strength, walking, pupil size, breathing and the heart beat. Some of the diseases that affect the brainstem can cause difficulty walking, coma and even death.

How do you reset a vestibular system? ›

In a sitting position, bend your head down to look at the floor then up to look at the ceiling.
  1. Lead your head with your eyes focusing on the floor and the ceiling.
  2. Repeat this 10 times. Stop and wait for symptoms to resolve, about 30 seconds.
  3. Repeat entire process 2 more times.

How Long Can dogs live with old vestibular disease? ›

Vestibular disease is simply a result of a more serious condition that could be fatal to your dog: Dogs with idiopathic vestibular disease or an ear infection may make a full recovery within 2-3 weeks and continue to live a normal healthy life.

Is vestibular disease in dogs neurological? ›

Vestibular disease is one of the most common neurological presentations in veterinary neurology and can be one of the most challenging. The vestibular system or apparatus, as it is also known, is responsible for maintaining balance, posture, and the body's orientation in space.

What is a vestibular episode? ›

What is vestibular disease? Vestibular disease refers to a sudden, non-progressive disturbance of balance. It is more common in older dogs. It is also referred to as old dog vestibular syndrome and canine idiopathic vestibular syndrome.

Can a dog stay on gabapentin long term? ›

You may be wondering how long can a dog take gabapentin, since epilepsy can be a life-long condition. With epilepsy in dogs, gabapentin is taken as long as the pup needs it, which can be months or even years.

Is human gabapentin the same as dog gabapentin? ›

Often better recognized by its brand name, Neurontin, gabapentin is FDA approved for use in humans. However, like many medications, vets can, and often do, use it “off label” in dogs. This means it's used in a way that's not included in the FDA's approved packaging label and insert.

What drugs should not be taken with gabapentin for dogs? ›

The following medications should be used with caution when given with gabapentin: antacids, hydrocodone, or morphine. Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking.

Does vestibular disease in dogs recur? ›

While idiopathic vestibular disease can recur in dogs after initial improvement, it is less common than with strokes and the interval between episodes is typically longer with idiopathic vestibular disease (months or more) versus strokes (days to weeks or more).

Why is my dog wobbly all of a sudden? ›

Potential causes include inner/middle ear infections, intoxication, strokes, tumors, infectious or inflammatory diseases (meningitis), idiopathic vestibular disease (also called “old dog” vestibular syndrome), or other less likely causes.

Is vestibular disease in dogs a stroke? ›

While it's not the fanciest disease name, old dog vestibular disease looks like a stroke. In actuality, it's an acute inflammation of the vestibular nerve. This nerve runs through the inner/middle ear and stems from the brain, and its purpose is to help us all to stay physically balanced.

Is vestibular disease neurological? ›

Vestibular diseases are the result of a problem with the nervous system, so it is categorized as a neurological disorder. Either there is a problem with the nerves in the inner ear, the peripheral system, or with the central system, the brainstem.

Can Benadryl help vestibular disease in dogs? ›

In addition to helping manage allergic reactions and symptoms, Benadryl also decreases anxiety and anorexia in dogs. Besides this, Benadryl will reduce the severity of head tilts in dogs with vestibular disease. It also helps calm your dog. In addition, the medicine is generally safe.

Can vestibular disease happen twice? ›

Most cases of idiopathic vestibular syndrome improve within several hours to a few days but could take days to weeks to completely resolve. This syndrome can occur again at some point in your pet's life, however it cannot be predicted.

Can vestibular disease cause death? ›

In addition to controlling head and body position and therefore balance, the brain also controls level of awareness, strength, walking, pupil size, breathing and the heart beat. Some of the diseases that affect the brainstem can cause difficulty walking, coma and even death.

Why is my dog walking like it's drunk? ›

When a dog seems to be walking with lack of coordination, loss of balance and staggering as if they were drunk or drugged, it means that they have ataxia. Not a disease in itself, ataxia is a symptom of disease which means they have an alteration i their gait.

Why is my dog shaking and losing balance? ›

Your dog's loss of balance could be the result of a serious medical issue, such as poisoning, stroke, injury, or an infection. Today, our Winston-Salem vets explain why you should head to an animal hospital right away if your dog is experiencing balance issues.

Why is my dog shaking and having trouble walking? ›

In some cases, shaking and trouble walking in dogs can be indicative of some type of orthopedic problem such as injury to a dog's leg or a spinal problem. A slipped disk in the spinal column is very painful for dogs and may lead to shaking, drooling and panting from pain.

Can vestibular disease cause paralysis in dogs? ›

Symptoms & Signs of Issues

There is staggering (ataxia), flicking of the eyes (nystagmus) from side to side, up and down or even rotationally, and a head tilt to one side. Facial nerve tics or paralysis are sometimes present.

Can vestibular disease in dogs cause seizures? ›

Similarly, diseases affecting the balance centre in the brain can also affect other parts of the brain causing seizures, weakness, loss of vision, or difficulty eating and drinking.

Can I give my dog Dramamine for vestibular disease? ›

What is dimenhydrinate? Dimenhydrinate (brand names: Dramamine®, Gravol®, Travtabs®, Driminate®, Triptone®) is an antihistamine used to prevent motion sickness and to treat nausea, especially in dogs with vestibular disease.

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