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.