Our poor 14-year-old Australian shepherd dog lost all sense of balance overnight and is now staggering around drunkenly, turning in circles and falling over. We were sure he’d had a stroke. The vet assures us it’s self-limiting and he should be better within a week or two. But we thought we’d have to have him euthanized. Everyone I’ve mentioned this to has said, “Oh, that happened to our [aged dog/cat name here].” Are there any good ways to avoid or deal with the syndrome so the poor, scared dog doesn’t hurt himself?
The syndrome you’re describing, idiopathic vestibular disease, is one of the most common neurological diseases of older dogs. Idiopathic just means “of unknown cause.” The signs — which are dramatic and come on suddenly — are frightening for both owners and their pets, and because the disease mostly affects older dogs and cats, many distraught owners think it’s the end of their pet’s life and even choose euthanasia. However, signs usually improve over a few days and resolve within a month, so it’s important not to panic. Here’s what you need to know.
What is the vestibular system?
This group of sensory structures provides the body with information on orientation (which way is up) and is responsible for adjusting eye movement and posture when you turn your head. It includes several intricate structures in the inner ear that detect head position, as well as the cranial nerve and the part of the brain that coordinates the movement of the eyes, head and body to control balance. When you read a book or your phone while riding along a winding road, your vestibular system receives confusing signals, leading to motion sickness. That queasiness usually resolves when you keep your eyes on the road.
What are signs of vestibular disease in pets?
Both humans and animals can experience vestibular problems. Affected animals stagger, walk in circles, repeatedly fall or roll over, have a head tilt, have rapid eye movements and can even vomit (although not all these signs are consistently present). The signs can start so suddenly — and be so violent — that owners may think their dog is having a seizure. Pets can’t tell us their symptoms, but you can probably empathize with them by taking a ride on a playground merry-go-round, cranking up the speed for a while, then stepping off. You’ll likely feel dizzy and nauseous, and be unable to see properly or walk in a straight line. If you’ve ever had vertigo, you might also know how they feel.
What causes vestibular disease?
Damage to any part of the vestibular system can cause these signs. The damage could be due to an infection (most commonly an ear infection, but also infections of the brain), a brain tumor, head trauma, certain inflammatory diseases or a problem with blood supply to the brain (similar to a stroke, although animals don’t experience strokes like humans do).
Certain drugs can also be the culprit. Vets who commonly treat ear infections (such as veterinary dermatologists) are wary of the unpredictable vestibular effects that topical ear medications can have, especially if your dog’s ears have to be flushed under anesthesia. Usually the signs resolve within a few days, but sometimes they can be permanent and even lead to euthanasia, so although this is rarely an issue, we always warn pet owners about it.
At high doses, the antibiotic metronidazole can damage the vestibular system. Metronidazole tablets are commonly used in dogs to treat parasites and diarrhea (although its use to treat diarrhea is controversial and it’s often overprescribed). Signs of metronidazole toxicity go away when treatment is stopped, but I know of more than one situation where a vet recommended euthanasia because they failed to recognize the toxicity.
All these things sound scary, but by far the most common cause of vestibular signs in older dogs is idiopathic vestibular disease (IVD), which often resolves completely without treatment. Although we don’t know the cause of IVD, the signs suggest that the inner ear is affected. As with several human peripheral vestibular diseases, the signs usually get better in one to two days and almost always resolve within two to four weeks. Occasionally, though, dogs are left with mild signs like a slight head tilt for the rest of their life.
How do vets diagnose idiopathic vestibular disease?
By ruling out other causes. The best way to avoid spending thousands of dollars on expensive tests like bloodwork or CT or MRI scanning is to wait a few days to see if the signs start to improve. Vets can often make a presumptive diagnosis based on the history (age of the pet, onset of signs, medications) and by doing a thorough physical and neurological exam. Adrien Dupanloup, a veterinary neurologist at the University of California at Davis, said “breed can also be a clue, because IVD is particularly common in older Golden retrievers and cocker spaniels.” He recommends taking videos of your pet and sharing them with your vet, with updates over time.
What can I do to help my pet while it recovers?
Although intravenous fluid therapy and prescription anti-vomiting drugs like ondansetron can help with nausea, Dupanloup says there are no drugs known to improve the neurological signs. “It’s mostly nursing care that’s needed,” he said. “Affected pets should be kept in an area where there’s soft bedding, and away from things like stairs and swimming pools, where they could hurt themselves. If they are having trouble eating, they can be fed canned food by hand. Although owners might be tempted to put them in a dark room, that often makes things worse — it’s best to keep the light on all the time, including at night, which helps them to compensate and recover more quickly.”
What if my pet is not getting better?
If your pet’s signs are not improving or they’re getting worse, your vet will likely recommend other tests, such as infectious-disease tests and imaging of the head. If you can afford it, consider seeing a board-certified veterinary neurologist. In cats, vestibular signs are often caused by problems other than IVD, so see your vet as soon as possible.
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