If you spin around in circles as fast as you can and then attempt to walk in a straight line, you’ll experience what your dog probably feels like if she’s suffering with vestibular disease. There are two types of vestibular disease: peripheral and central. In this article, we will discuss the peripheral form, which, with treatment, generally carries a good prognosis and is much more common than central vestibular disease, which attacks the central nervous system and brain.
Dogs with peripheral vestibular disease have a breakdown in communication between the inner ear and the brain, causing dizziness. Though this disease can be debilitating for your furry friend, it is not life-threatening. Peripheral vestibular disease generally affects senior and geriatric dogs over 8 years of age. Its most common cause is inflammation of the nerves that connect the ear to the brain, most often caused by chronic or recurrent ear infections. In some situations, vestibular disease can result from a lesion or infection in the brain, a stroke, or a head injury. In some older dogs, vestibular disease occurs suddenly, with no known underlying cause.
The most common symptom of vestibular disease is loss of balance. No, your pooch hasn’t been hitting the bottle…but it may look as though she has! If the disease only affects one ear, your dog may walk with a tilt or in circles.
Other symptoms might include:
- Inability to stand
- Repetitive eye movement (nystagmus)
- Incoordination (ataxia)
Once consulted, your veterinarian will perform a thorough physical exam, looking carefully at your pet’s ears, and may recommend diagnostic tests to look for concurrent conditions and to rule out other disorders that mimic vestibular disease.
These tests could include:
- Chemistry tests to evaluate kidney, liver, and pancreatic function, as well as sugar levels
- A complete blood count (CBC) to rule out blood-related conditions
- Electrolyte tests to ensure your pet isn’t dehydrated or suffering from an electrolyte imbalance
- Urine tests to screen for urinary tract infection and other disease, and to evaluate the ability of the kidneys to concentrate urine
- A thyroid test to determine if the thyroid gland is producing too little thyroid hormone
- A cortisol test to rule out Addison’s disease
- Antibody/Antigen tests to rule out parasitic infections
- Ultrasound examination of the abdomen to rule out tumors
Treatment will depend on the discovery of any concurrent conditions or underlying causes, such as an ear infection. If no cause is detected, your veterinarian will suggest supportive care that you can provide for your dizzy pooch as she recovers. The good news: most cases resolve quickly, with dogs recovering within a few weeks.
Keeping your pooch free of infection and clean will help to prevent vestibular disease caused by an inflammation of the nerves. Routine health care and physicals including diagnostic tests can identify—sooner rather than later—any underlying conditions that could possibly cause vestibular disease. Call your veterinarian immediately if your dog seems dizzy or “drunk”—vestibular disease can happen quickly and can be scary, for both you and your pet!
If you have any questions or concerns, you should always visit or call your veterinarian – they are your best resource to ensure the health and well-being of your pets.
How to Care for a Dog with Vestibular Disease
One minute your pup is fine, then without warning, they circle, tilt their head to the side, stumble a few steps and collapse onto the floor. Rather than a seizure or a stroke, it’s most likely vestibular disease.
Vestibular disease affects your dog’s inner-ear sensory receptors, one of the main components that control’s an animal’s balance. Vestibular structures send information to the brain about where the body is in space — whether it’s moving, standing, sitting, leaning or falling. When the vestibular system functions correctly, your dog can run, jump, balance and live an action-packed life.
But when vestibular disease occurs, a multitude of alarming symptoms arise.
What Causes Vestibular Disease?
Vestibular disease is often referred to as idiopathic, meaning the cause of the condition is unknown. Sometimes it can be attributed to ear infections, a reaction to certain antibiotics or head injury. Some dogs seem to have a genetic predisposition for the disease.
It’s often referred to as “old dog vestibular syndrome,” since it’s more common in older dogs. However, it can occur in dogs of any age and breed.
Luckily, this disease is not life-threatening, and symptoms typically go away as the vestibular system rights itself. Though minor, your dog may have a head tilt for the rest of his life.
What Are the Symptoms of Vestibular Disease?
The symptoms of vestibular disease are easy to spot, but the disorder is often mistaken for a seizure, stroke or brain tumor. Luckily, it’s not nearly as severe as any of those conditions.
Still, if your dog displays any of the following signs of vestibular disease, you should take them to the vet for a proper diagnosis:
- Walking in circles
- Standing with an unusually wide stance
- Tilting of the head, which can range from slight to extreme
- Falling or rolling to one side
- Acting dizzy
- Drifting or darting eye movements
- Squinting or another abnormal eye positioning
- Stumbling or lack of coordination
- Shaking head
Symptoms are typically acute, meaning they come on right away and without warning.
Look for other behavioral changes. If your dog loves to ride in the back seat, but suddenly begins experiencing motion sickness, or if they have to lay on their belly to drink from the water bowl, this could be a sign of vestibular disease.
What Should You Do If Your Dog Has Vestibular Disease?
Luckily, vestibular disease typically goes away on its own after a few days, though it may stick around for a couple of weeks, and the head tilt could remain for the rest of his life. If symptoms don’t begin to improve after 72-hours, this may be a sign of something more serious.
Even if you know your dog is suffering from vestibular disease and not a more life-threatening condition, it’s hard to watch them suffer. Here are five things you can do to help ease the symptoms.
- Take your dog to the vet — You should take your dog to the vet if they begin to show symptoms of vestibular disease, particularly if they’ve never had issues like this before, as they could be a sign of something more serious. Your vet can prescribe anti-nausea medication if your dog is vomiting.
- Assist your dog with essential functions — This may mean bringing food and water to them or keeping it nearby. Push their food and water bowl against a wall so they won’t drift when eating or drinking, and elevate them, so they don’t have to put their head down too far. Consider switching their food to something easy to eat and digest. You may also need a harness to help them get to their potty spot.
- Avoid carrying your dog — They need time to re-calibrate their vestibular system, which will occur as they begin to navigate their space again. Help them walk by placing your hands on either side of their body, or use a harness to help guide and support them.
- Keep your dog safe from harm — Limit the amount of space through which they can wander in your home. Keep them away from stairs and clear the floor of any clutter that your pet could trip over.
- Help them get comfortable — If your dog has trouble sleeping, try putting a rolled up blanket or towel under their head for support. Spend time on the floor with them while their world is all topsy-turvy.
Though uncomfortable, vestibular disease in dogs is luckily not too serious as long as your pet is well-cared for in recovery. Provide love and support for them, and they’ll be back to their fun-loving self in no time!
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Idiopathic or “Old Dog” Vestibular Disease
A fairly common reason for a veterinary visit is the concern that an older dog has had a stroke or a seizure, when the dog suddenly starts walking like a drunken sailor with his head tilted. I know of other cases, where these sorts of symptoms are assumed to be a brain tumor and the dog is euthanized—maybe unnecessarily.
Well, I want to shed some light on a much more common and less concerning cause of these and other disturbing symptoms, something known as idiopathic vestibular disease in dogs, in case it is something you ever experience with your own geriatric dog.
Idiopathic (meaning unknown cause) vestibular disease in dogs is a syndrome that looks really, really bad, but usually gets better all on its own with little or no treatment.
Vestibular Disease Symptoms
The vestibular system in dogs is composed of portions of the brain and ear and is responsible for maintaining a sense of balance. When something goes wrong with this system, it’s like being drunk on a rocky boat. Dogs with idiopathic vestibular disease typically have some combination of the following signs:
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- A head tilt
- An unsteady gait, loss of balance, or falling over (ataxia)
- Circling in one direction
- Eyes rapidly moving from side to side (nystagmus)
- Sudden vomiting
The videos at the end of this post show a dog with nystagmus, a dog with mild, but very typical, vestibular signs and another dog with more severe signs of idiopathic vestibular diease.
Now for the caveat: These clinical signs are unfortunately not unique, or diagnostic for, idiopathic vestibular disease and other things can cause this same presentation. Other illnesses that display these symptoms can include a brain tumor, an inner ear infection, inflammatory disease or sudden bleeds into the brain—to name a few. The sudden onset of vestibular disease can also look like a seizure the two are can hard to distinguish. Actually seeing the episode would be helpful for diagnostic purposes, so it might be good to record and show to your vet.
But with that being said, when the symptoms seemingly appear out of nowhere in an older dog, I always recommend a “wait-and-see approach,” treating symptomatically and supportively, as there is a good chance of improvement.
Diagnosis and Treatment
For a dog showing the above signs, I first discuss the possible causes. Next, I recommend blood work and a blood pressure check to make sure there is no “obvious” disease. I discuss the availability of an MRI to evaluate the inner ear and brain. Although an MRI allows for the best evaluation of disease, it is often not pursued due to cost (about $1,500 here in the Bay Area).
I examine both ear canals, and if an infection is suspected, I discuss antibiotic therapy, as inner ear disease is one of the possible causes of vestibular signs. The inner ear is something you cannot see during an exam because the eardrum obscures the view to the inner ear. The eardrum is like a closed door that sits in front of the middle and inner ear. However, if there is a nasty looking outer ear and an inflamed eardrum, there is a chance that inner ear disease could be present as well.
If clinical signs are mild, pets can often be managed at home with over-the-counter meclizine (for the feelings of “motion sickness” they experience). If the dog’s clinical signs are so severe that they cannot walk, I then recommend supportive care with IV fluids and injectable anti-nausea medications. Urinary catheters are sometimes placed for hygienic reasons. We also provide instructions for general nursing care as well as how to protect from falls.
The conversation ends with discussing a very loose rule of thumb: If there is gradual or complete improvement within 72 hours, it is likely the dog has idiopathic vestibular disease and additional diagnostic testing is not necessary. If there is no improvement or progression of signs, it is likely something much more serious, such as a tumor, and an MRI would be recommended to reach a definitive diagnosis. With idiopathic vestibular disease, marked improvement is usually evident in dogs within this 72 hour time frame. The dog should recover and return to normal in 7 to 14 days (although in some dogs, a head tilt will still persist).
It should also be noted that idiopathic vestibular disease in dogs is not a painful condition, and my recommendations stem from the fact that euthanasia is a permanent decision, so why not wait and see, giving time a chance? There is a high likelihood that improvement will be seen and the difficult decision of euthanasia can always be made at a later date if there is no improvement or if there is a change in your pet’s quality of life. I feel there is reason to hold out hope and be cautiously optimistic, as idiopathic vestibular disease is the most common form of vestibular disease in dogs. It is the direction I would take if it were my own boy experiencing this.
Please note: There are times, however, when a physical exam points undeniably to a brain tumor, but these neurological exam findings are beyond the scope of discussion, so feel free to ask me any questions.
Is It a Stroke or Old Dog Vestibular Syndrome?
One minute your dog is fine and the next they are staggering with their head listing to one side. It looks like the canine equivalent of a human stroke. What’s going on? While it could be a stroke or other serious condition, in a gray-muzzled dog, it’s often idiopathic vestibular disease, more commonly known as what’s called old-dog syndrome. And that’s actually good news.
Located in the inner ear and brain, the vestibular system helps dogs maintain balance and coordinate the position of the head, eyes and legs. Anything that disrupts this system can throw your dog’s balance out of whack. And in older canines, it’s not rare that this happens. This syndrome is considered to be “idiopathic,” meaning that no one knows, exactly, what causes it. While old dog vestibular syndrome generally affects older dogs, it can occur in cats of any age.
You’ll know it when you see a sudden head tilt, loss of balance, falling or rolling to one side, circling, trouble walking and abnormal eye movement, often from side to side. As you can imagine, these symptoms are often accompanied by dizziness, nausea, vomiting and loss of appetite.
Although these signs can be frightening, the good news is that most dogs recover from vestibular disease. While some may retain a head tilt, they seem to regain their sense of balance and do just fine.
Strokes Can Have Similar Signs
Like humans, dogs can have strokes, but they typically aren’t as common as in people. Strokes can be caused by the rupture of blood vessels or blocked arteries in the brain. They can also be caused by fibrocartilaginous emboli (FCE), or material that travels through the blood and lodges in a blood vessel, often in the spinal cord.
Like vestibular syndrome, a stroke or FCE can occur suddenly. With the latter, especially, a dog may leap after a tennis ball, yelp with pain and immediately have difficulty walking. This can occur in dogs of all ages. Signs of a stroke can be subtle but may also include head tilt, circling, weakness, paralysis of one or more limbs, loss of urine or bowel control and collapse.
To complicate matters, other conditions can cause signs similar to old dog vestibular syndrome, including inner ear infections, hypothyroidism (low thyroid hormone), toxins, trauma, infectious diseases or brain tumors.
Pinpointing a Cause
Because these signs can indicate a potentially serious disease, it’s important to see your veterinarian as soon as possible. The doctor will perform a full physical exam, including looking for signs of potential inner ear infections and neurological problems. In addition to possible blood or urine tests, your veterinarian may recommend x-rays to help visualize the middle and inner ear, which can’t be seen on physical exam.
A Wait-and-See Approach
In many cases, the veterinarian may monitor older dogs before performing more tests. While the signs can be severe for 48 to 72 hours, those with old dog vestibular syndrome often improve gradually over the next few days to weeks.
Dogs that don’t show signs of improvement in a few days typically require additional diagnostics, which may include magnetic resonance imaging (MRI) or computed tomography (CT) for evidence of a stroke or other brain lesions.
Your veterinarian may prescribe medications to help reduce motion sickness. It may also help to hospitalize the dog, or limit them to an area of the house with soft carpeting and no stairs to help minimize possible injuries from falls. With prompt veterinary attention, most dogs with old dog vestibular syndrome — and strokes — eventually recover.
The information in this blog has been developed with our veterinarian and is designed to help educate pet parents. If you have questions or concerns about your pet's health or nutrition, please talk with your veterinarian.
Pets & Vestibular Dysfunction
Vestibular disorders are not unique to humans. All higher animals that have a vestibular system—from fish to mammals—can be afflicted, including cats and dogs.
The vestibular (inner ear) organs provide the brain with vital information about body position with respect to gravity. Sensory information from the vestibular system tells dogs and cats if they are upside down, right-side up, tumbling, turning, falling, or accelerating. Information from the vestibular system also coordinates with sensory information from vision and proprioception (touch sensors in the paws and other parts of the body) to help your pet maintain balance and have clear vision while moving. When vestibular dysfunction occurs in dogs or cats it is most often associated with the peripheral system (inner ear) rather than with the central system (brain).
How do I know if my pet has a vestibular problem?
Signs of vestibular disease in pets can include:
- Circling (spinning or walking in circles)
- Standing with an exaggerated wide stance
- Head tilting
- Falling or rolling to one side
- Nystagmus (involuntary drifting eye movements)
- Squint or strabismus (abnormal position of the eyeballs)
- Ataxia (stumbling, staggering, or lack of coordination without weakness or involuntary spasms)
- Head shaking
- Motion sickness—perhaps evident when your dog is no longer an enthusiastic backseat companion on car rides
Other behavioral changes may be apparent. For example, a cat’s swift and graceful movements may become hesitant and awkward. A dog that is disoriented when looking down may rest on his belly in front of the water bowl to drink rather than stand to slurp from it as usual.
In addition, your pet may opt to sleep on the floor rather than on his pillow or a sofa because the hard unyielding surface will help him to reduce being awakened by the vestibular signals triggered with subtle head movements and position changes in sleep. This is because the vestibular system sends information to a part of the brain called the reticular formation, which is involved with self-regulation of wakefulness—in part, a monitor for survival. For example, if you or your pet were to start falling off of a bed while asleep, sensory signals sent from the vestibular system to the reticular formation would stimulate arousal.
The activity in the reticular formation with specific head and body movements is why veterinarians will hasten an animal’s recovery from anesthesia by rolling the animal from side to side. Similarly, your pet may not sleep soundly if his brain receives false or exaggerated sensory information from his malfunctioning vestibular system about movement and spatial orientation.
(left) Bolivar at the onset of vestibular disease.
In January 2011, Bolivar suddenly couldn’t walk straight. His owners reported that he was “not his ridiculous, bouncy puppy-like seven-year-old self.” But after four weeks, he’d significantly improved. Happily, his owners now tell us “He is mostly better. He has a few trace symptoms still, perhaps the most significant being that he can’t keep track of a thrown ball any more. So we just roll it gently, and he loves playing chase as much as he ever did.”
Peripheral vestibular dysfunction in dogs and cats is usually of unknown (idiopathic) origin. Less common causes are middle ear infection (e.g., from a severe ear mite infestation), ototoxicity from certain types of antibiotics (e.g., streptomycin or gentamicin), genetic sources, and head trauma. An underactive thyroid gland or central problems (brain lesion) can also create vestibular dysfunction in pets.
The term old dog vestibular syndrome has been used to describe a disturbance of unknown (idiopathic) origin in the inner ear balance system in dogs. However, such inner ear disturbance can occur in dogs of any age, so the term canine idiopathic vestibular disease is more accurate. The equivalent term in cats is feline idiopathic vestibular disease.
How can I help my pet?
As in humans, treatment for a vestibular disorder in dogs and cats depends on the specific diagnosis. It is important to have your pet examined by a veterinarian to rule out conditions such as stroke or hyperthyroidism. The examination may also reveal an underlying and treatable condition affecting the inner ear. For example, if an ear infection is inflaming the tissues and nerves of the vestibular system, an important part of treatment will be to eliminate the infection.
If the problem is diagnosed as the more common condition of canine- or feline idiopathic vestibular disease, a veterinarian may prescribe some medication to reduce your pet’s nausea in the short term but will often adopt a “wait and see” approach to treatment. During this period, you can help your pet’s recovery in several ways:
- Give your pet time. The sudden onset of symptoms is disconcerting to owners, often resulting in an understandable sense of urgency. However, feline- and canine idiopathic vestibular disease are not life threatening. Most pets with good general health will naturally adapt and compensate such that symptoms begin improving within about three days and almost completely resolve in two weeks, although a head tilt may remain.
- Comfort your pet by managing your own stress. Pets are very sensitive to the mood of their companions. The less agitated you are about your pet’s illness, the calmer he will be.
- Provide a quiet resting spot. Make sure that your pet has a place to rest away from the bustling activities of the household. For example, minimize your pet’s exposure to enthu¬siastic toddlers and loud televisions. Encourage your pet to avoid settling in the middle of a traffic pattern. Even though you may be attentive to cautiously stepping around or over him, your pet’s heightened motion sensitivity may make him startle easily.
- Provide lighting and proprioceptive support. Good lighting is essential so that your pet can use visual cues to confirm or adjust to the signals about head position sent from his vestibular system. Also consider providing a proprioceptive “surround” for your pet to nestle against. To do this, take a long thick blanket, roll it up like a jelly-roll, and then snuggle it around your pet in a C-shape.
- Avoid carrying your pet. In the same way that a human with a vestibular disorder needs to move about to help recalibrate sensory information, your pet needs to retrain his system by navigating on his own. The touch sensors in a pet’s paws provide useful sensory information about balance when he walks or runs but they won’t be activated if his paws are dangling in air. For this reason, avoid carrying your pet. Instead, help him to walk on his own by placing your hands on both sides of his body. If he starts tilting, he will feel increased pressure of his body against your hand, and these proprioceptive cues will help him know to adjust his balance. An alternative way to assist your pet in walking is to support him with a sling or towel looped under his belly. If carrying your pet is unavoidable, lift him slowly and hold the pads of his paws while you are moving.
The importance of a healthy vestibular system
The vestibular system is fundamental to the well-being of humans, dogs, and cats. It allows us to recognize where we exist in space and how we are moving. It helps us to make adjustments that preserve and maintain our balance and clear vision—which is why the vestibular system is vital to survival for animals in the wild. In domesticated pets, peripheral vestibular dysfunction often results in severe and disconcerting behavior changes. However, with a proper diagnosis, the safety of your home, and your care, your pet’s condition can often resolve.