Our doctors at the Animal Clinic at Thorndale often see dogs with problems walking. The sudden onset of vestibular syndrome, in some cases, can make an owner think their dog has had a stroke. These dogs may appear to be falling over to one side, staggering, being reluctant to stand, or even persistently circling in one direction. In-coordination, or the inability to keep the body in a balanced position is often due to middle and inner ear problems or neurological problems involving the balance center (vestibular nucleus) of the brain. Most frequently, the underlying cause of the vestibular syndrome is not diagnosed. Seeing your dog with the signs of vestibular syndrome can be frightening. The good news is that most of these dogs can recover their quality of life with good supportive care.
Prevalence of Vestibular Syndrome
Vestibular disease is most common in older dogs, greater than seven years of age. It is sometimes referred to as the “old rolling dog syndrome”, or “old dog vestibular syndrome” but it can occur in younger dogs as well. There is no reported breed or sex predilection.
Clinical Signs
Typical signs of vestibular disease are those of vertigo, including head tilt, staggering or falling to one side, inability to stand or stay standing, swaying of the head, staying crouched low to the floor legs splayed wide, one directional circling, nausea and vomiting. The dizziness may cause these dogs to have a poor appetite and be reluctant to drink, potentially resulting in dehydration. Many of these dogs will show nystagmus, an uncontrolled movement of the eye in one direction followed by a rapid “clicking back” to the original position. The signs are usually worse during the first 24-48 hours after onset.
Diagnosis
A thorough physical examination, including an otoscopic exam can help rule in or out a primary ear problem. Nystagmus is often present, and typically worsened by raising the dog’s nose vertically. Most cases are tentatively diagnosed based on age, history, presentation and physical examination. Complete blood count and chemistry, and thyroid testing, can rule out metabolic disorders that might be contributory or co-existing. Additional tests, such as MRI and CT scan may be helpful when looking for tumors in the middle or inner ear and the vestibular nucleus of the brain. These test may become more important if the patient does not respond to initial therapy.
Causes and Transmission
Causes of vestibular syndrome are infections of the middle and inner ear, drugs that are toxic to the ear, either taken orally or applied topically, trauma or injury to the head, tumors of the ear canal, middle or inner ear, or brain. Hypothyroidism may be contributory. Frequently, no underlying cause is diagnosed, and the condition is then termed Idiopathic Vestibular Syndrome. Vestibular syndrome is not transmissible between pets or to their humans.
Treatment
Treatment depends on the identification of an underlying cause. Idiopathic vestibular syndrome is the most common finding, meaning we cannot identify an underlying cause. These dogs respond best to supportive home care. Helping the dog to walk with a sling, assisting in access to food and water, propping them up in a safe and stable place, along with basic supportive care will get most dogs to an acceptable level of functional recovery. Dehydrated dogs may need treatment with subcutaneous or intravenous fluids. Medications to help with nausea, such as meclizine or dimenhydrinate, or to stop vomiting, such as maropitant, can improve quality of life during the acute phase. Ear problems are treated with oral and topical antibiotics and/or anti-fungal medications, and surgery in some cases.
Response to Treatment and Relapses
Most dogs improve within 72 hours, again able to stand, walk, eat and drink. Many will continue to improve over the next several weeks. Frequently there will be a residual head tilt or listing of the body, causing the dog to track a bit more toward one side when walking. Our doctors at the Animal Clinic at Thorndale always encourage owners to be patient.
Relapses can occur in some dogs. Again, symptomatic treatment and supportive care can return them to a good and functional quality of life.
If despite treatment and “tincture of time” the dog’s condition seems to worsen, other testing for more serious neurological problems should be considered. Fortunately, most of our vestibular syndrome dogs will recover their quality of life with good care by their owners.