Vestibular Disease in Small Animals || Facebook Live Q & A with Dr. Wong

Is your pet walking with a head tilt? Do they seem uncoordinated and wobbly? They could have vestibular disease. In simple terms, this means balance problems. In this Facebook Live, Dr. Wong discusses vestibular disease in small animals including its symptoms, diagnosis, treatment and prognosis.

The vestibular system is the part of the nervous system responsible for maintaining balance and coordination. When the vestibular system is affected, the symptoms may include a head tilt, walking/falling/rolling to one side, abnormal eye movements (called nystagmus) and abnormal eye position (called strabismus).

The balance system is made up of two main parts: the peripheral vestibular system (the parts of the balance system within the inner ear) and the central vestibular system (the parts of the balance system within the brain).

It is important for veterinarians to determine whether the problem is affecting the peripheral (inner ear) or the central (brainstem) vestibular system as this affects the list of possible causes, the recommended tests, the treatment options and the likelihood of getting better (the prognosis).

Both peripheral and central vestibular disease can cause head tilt, vestibular-quality ataxia (leaning/falling/rolling to the side). Distinguishing between central and peripheral vestibular disease relies on finding other symptoms that could not be explained with a problem affecting the inner ear. These include vertical nystagmus (abnormal jerking movements of the eye in an 'up and down' direction), postural reaction deficits (knuckling or not replacing the paw when it is turned over), changes in level of alertness, other cranial nerve deficits or cerebellar signs.

Causes of peripheral vestibular disease include idiopathic or old dog vestibular disease, inner and middle ear infections, tumors, certain drugs and others.

Causes of central vestibular disease include brain tumors, strokes, encephalitis, metronidazole toxicity and others.

An MRI is usually required to diagnose most of these causes. CT scans and X-rays are typically. not sensitive enough. The treatment and prognosis varies for each of the diseases, so it is important to find the cause.

There are times when it is okay to not proceed with tests. The times are when the owner is unable to afford testing such as an MRI, if the owner does not want to pursue with tests, or if the pet is too sick for anesthesia. In these cases, a trial of medications can be tried. Sometimes no medications are necessary and patients will improve on their own, such as with old dog vestibular disease.

However, since many of the diseases that can cause vestibular disease are serious (such as encephalitis, strokes and tumors), it is recommended to pursue evaluation by a neurologist and advanced testing including MRI.

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