Sunday, January 8, 2012

Geriatric Vestibular Disease

Also known as Idiopathic Vestibular Syndrome, this can be a very scary disease when you don't know what is happening.  Hopefully by writing this some of you will be prepared if it happens to your pet and won't panic!

So that's a pretty long, fancy name right?  But it really doesn't mean much.  Geriatric obviously means old, idiopathic means we don't know the cause and vestibular has to do with the balance system.  This is essentially a disease of older dogs that causes dizziness and ataxia (off-balance) for no apparent reason.

Most dogs affected are older than 8, but it seems like the dogs I have seen with this condition are significantly older than that, often at least 12 years old.  It is most common in medium to larger dogs with all breeds and both sexes affected equally.  Other than being older, there appear to be no predisposing factors.

The onset is typically very sudden and can be very profound.  Classical presentation is a dog with a head tilt, ataxia with falling, leaning, or circling to the side of the head tilt, horizontal nystagmus (back and forth eye movements), vomiting and nausea.  The dogs may be unwilling to stand and walk due to the effect of motion sickness but they are able to walk.  Reflexes and strength remain normal.  Many owners (and some veterinarians) will misdiagnose this condition as a stroke or sometimes a seizure.  Because there is suddenly something very wrong with their very old animal most owners fear the worst and arrive at the vet clinic in tears and prepared to say their good-byes.

But this is a good news disease!  And actually a great disease for the vet because is makes them look a hero when after a brief exam they get to announce that your pet will likely be fine in a few days!  Although we don't know what causes it, this disease usually runs it's course over a few days to a few weeks.  Dogs are usually significantly better in 72 hours with a full recovery in a few weeks  Although at least a partial head tilt may remain for life.  Relapses occur occasionally.

I typically recommend some baseline bloodwork to check for other underlying conditions but if an owner is on a budget this is not a mandatory part of diagnosis or treatment.  Treatment is supportive with appropriate medications to fight the nausea and motion sickness and ensuring adequate food and water intake.  IV fluids may be necessary in severe cases as well as assistance when walking or going out to urinate and defecate.

If signs are not improving over a few days or are progressive then advanced diagnostics such as CT or MRI may be needed to look for a brain lesion.  Although brain lesions usually present with different or additional signs than vestibular cases.  I have diagnosed this a handful of times and none of those cases turned out to be a brain tumor or other disease with a poor prognosis.

Inner or middle ear infection can also be a differential but this can usually be ruled out with history and examination.

As a side note true stroke in dogs is rare but you can read about it here.

This condition can also occur in cats but is quite rare.  I think I have yet to diagnose this is a feline.

4 comments:

Sue said...

We're aware of vestibular disorder as it seems relatively common in our breed. I did have experience with a stroke in my 15 year old Boxer mix. That was the diagnosis, but she died the next day so we're not sure what was going on besides the fact that she was old.

K-Koira said...

Sounds a lot like vertigo issues in people- most doctors have no idea why they happen, and have close to no helpful advice or treatment to make it go away.

Jenniferlynne said...

Tuesday afternoon (2 days ago), my 13 year old Golden/Red Doberman suddenly developed a head tilt, began stumbling and having trouble walking and i noticed that his eyes were going side to side in the sockets. I've cared for a dog that had Vestibular syndrome before, so I wasn't FREAKING OUT, and I know that sometimes it gets worse before it gets better...but it is such a hard thing to watch. Poor guy can't stand up at all, he tries, but then plops back down. He has not been able to go out to the bathroom now since tuesday PM, so ALL DAY yesterday and so far today, he hasn't been able to relieve himself, but he hasn't had an accident yet either...I try to help him stand when he looks like he's trying to get up, but it doesn't help ..he just can't.

I was giving him dramamine for the nausea, and he took two doses yesterday am & pm, but today he won't take any food...

Now...another symptom is developing...His left eye (same side as the head tilt) is swelling...

I'm praying this is strictly geriatric vestibular disease and not something worse... I'm alone, with a small farm to care for in a very remote area ...if I can't get him to stand, I can't get him out to pee, there is NO way I can get him to the car to go to the vet...

supportive care, is the best i can do...but it just doesn't seem like enough...

fingers crossed in another day he will start to improve...

I love my boy...and it is breaking my heart...he doesn't seem to be in pain...he's just immobile & quiet...

any hoo...since I'm alone with this & i found this blog...it felt good to write it all down ... i see it's an old post...but if you have any advice...I'd love to hear it...

Anonymous said...

Not sure if what my border collie went through was vestibular disorder or a series of strokes. The first bad one she encountered was at age 14. She would get up and just fall flat with all four legs spreading out beneath her. She also would be walking along and just fall over for seemingly for no apparent reason. She recovered completely from the first bout after about three weeks with substantial improvement during the first week.

During the next three years she had five more episodes of the same problem some quite a bit more severe than others.

At 17 she was hit hard and effected her to the point of being debilitating. She went from being an active and spry older dog to a cripple instantly in one afternoon. She had a hard time maintaining balance to even walk at all. She would veer off into one direction or walk in circles often falling down. She acted as if she was often disoriented and didn't know where she was. She couldn't keep her balance while doing her bathroom functions. Her head canted to one side and constantly twitched back and forth. She lost her appetite and no longer had the desire to eat. So watching her suffer and her quality of life diminish with no signs of improvement, I made the decision to put her to sleep.

17 years is a good full life for a dog. She was with me everyday everywhere I went. I miss her dearly.