Vestibular disease
Question: Dr. Richards, We have a 13 year old male-neutered golden retriever who has started having some physical problems. He began walking as if he were drunk. His front legs kept crossing each other and hind legs appeared as if they were protruding out to both sides. He walked with his head down, tail between his legs, head with a tilt to the left. He was lethargic and different from the dog we have had since birth. After several visits to our vet they suggested we go to Tuft`s Vet. Clinic for another opinion. All veterinarians feel that there may be three possibilities: 1. Brain tumor. 2. vestibular disease 3. stroke
Now it is 12 days later and he is doing better-not swaying and acting happy and normal. At Tufts the Dr. used the term ataxic cerebral. I was wondering if you would help us to better understand this term and also your opinion of his condition. His x-rays, ultrasound, blood pressure and blood work are all normal. Thanks for your help. Gina
Answer: Gina;
I am sorry for the long delay in responding to your question. I have been unable to find any references to the term "ataxic cerebral". If I use cerebral ataxia as the search term I do get some responses, though.
Cerebral ataxia refers to loss of motor function and/or balance (ataxia) that leads to difficulty walking and arises from damage to the cerebrum (the frontal portion of the brain). This generally takes a pretty widespread lesion and the most common one, I think, would be granulometous meningioencephalitis or GME. Head trauma would be another possibility and brain tumors have to be included in the list of things that can do this. In cats, there is a condition in which an artery to the brain is injured, feline ischemic neuropathy, that leads to cerebral ataxia but this would be a really unusual problem for a dog, as would a stroke, which is another possible cause of these symptoms. Liver failure can lead to generalized neurologic signs due to toxin formation. I strongly suspect that cerebral ataxia is not the problem with the recovery your dog experienced, though. I am not a neurologist, so my list probably doesn`t include all the possibilities and I am not actually sure about the order of probability. Brain tumors could easily be more common than GME, for instance.
My guess is that this was peripheral vestibular disease, which often affects older dogs and usually goes away on its own. But the main reason I think that is because of the recovery, which I hope has continued on until now, as it is a big hint in this case.
If this does recur or if you need additional information please feel free to write again.
Mike Richards, DVM 6/27/2001
Question: Dr. Richards;
I found your website by doing a lycos search, looking for more info on a diagnosis given me by my vet. I just recieved your e-mail welcoming me to vet info, I just joined today,( boy that was quick!).
I was told by him that my approximately 10 year old nuetered male springer, ziggy, has geriactics disvicular (sp?) disease. He took a x-ray of his abdomen and a blood test, both of which came back normal.
Ziggy was exibiting a severe head tilt to the right, unsteadyness and loss of appetite and balance. He also seemed to be drinking more water than usual, along with more urine output. The sugar levels were also normal.
My vet said he would get over it rather quickly and gave me some 10 mg prednisolone to administer after the blood test results came back.
Ziggy has just about returned to normal, with just a little abnormal head bobbing left. This all started suddenly last wed. nite 01-10-01 I took him to the vet on fri. and started the pills on sat.
I guess what my question is, what causes this disease, and will it reoccur? I live alone and he is my close companion and almost the only company I have. I want to prolong his life as much as possible. My vet said lots of dogs get it in their later years, but I`ve never heard of it.
Thanks much for your website, it was the only one of the 100`s I looked at that tried to answer questions from pet owners. I look forward to reading some of the past issues of the digest as well as future issues.
Jim
Answer: Jim;
Geriatric vestibular syndrome, which is also called peripheral vestibular syndrome and idiopathic vestibular syndrome, occurs for unknown reasons. It can be really frightening, especially in dogs that can`t even lay still because they just roll over and over until something stops the movement. However, like your experience, it usually clears up within a few days and most dogs never have another recurrence. Some dogs seem to have the problem with a head tilt in one direction and then have it again at another time with the head tilt in the other direction, but this isn`t too common. We have had one patient who had a number of episodes of this condition. So many that we referred him to the neurologist at our state`s veterinary school. Over the course of a year he had a number of short episodes of balance loss and then lived for several more years with no problems.
There are some other causes of vestibular disease and if any signs of this problem persist beyond three weeks it would be best to have Ziggy rechecked by your vet. The odds are high that won`t be necessary, though.
Mike Richards, DVM 1/23/2001
Peripheral vestibular syndrome in golden retriever
Question: I have a golden retriever that is approximately 11-12 years old (we aren`t quite sure as she was an orphan we adopted) 8 years ago. She had a seizure this morning and is at the emergency vet at this time. This is the third one she has had. The last one was July of 1999. Usually she comes out of these immediately. Our normal vet gives her steroids and fluids and usually by the time we have arrived at home the vet is calling to say she is ok. This time however, we took her to the vet at 3:00 A.M. and it is now almost 3:00 P.M. and she has not come out of the seizure. The emergency vet gave her diazepam and dexamethasone this morning. Of course she slept for a long while, but when she woke up she was still rolling over and her legs are stiff and turning in and unable to stand.
I am very confused about this. Our vet keeps saying she probably has a brain tumor and it is often found in goldens. However, this emergency vet thinks it is idiopathic vesticular disease. Her blood work from last July showed nothing unusual.
They keep mentioning giving her an MRI and maybe surgery at Texas A&M. Now this morning I was told she would not be a candidate for surgery because she is so old.
Is there not something that can be done to find out what is wrong with our dog? Any help you can give me will be very much appreciated.D;
Answer: If this problem is peripheral vestibular syndrome, there should be a rapid improvement in clinical signs over the next few days. If you do nothing else, waiting two or three days to see if things improve is worthwhile. Peripheral vestibular syndrome is very common. Brain tumors are much less common but are possible. A disorder known as granulometous encephalopathy (GME) can produce the signs that you have seen in your dog but it is more common in small and toy breed dogs. Inner ear infections can produce the balance problems and difficulty walking but do not usually cause seizure activity --- although they can occur coincidentally with pre-existing seizure activity. Infection or inflammation of the brain can also occur and produce a variety of clinical signs, as well.
An MRI or CT scan is the best way to determine if a brain injury or tumor is causing the problems seen. This test is somewhat expensive but could potentially provide a rapid diagnosis. If there is not a lot of improvment in clinical signs pretty rapidly, then it would be worth doing this if you want to know what is going on and if the cost is not prohibitive for you. While I do not practice in Texas and am not sure of this, I would think there is a strong possibility that Texas A&M does have either an MRI or a CT scanner and will have a neurologist who can help in determining the best diagnostic tests to run, as well. Even if you do not wish to pursue an MRI consulting with a neurologist could be very helpful.
As long as your dog can be kept comfortable you have time to wait and see what happens or to consult with a neurologist. If there is no improvement within a day or so or if you do make a visit to the neurologist and he or she confirms your vet`s suspicions, then the decision making will get harder but you will also have a more clear picture of what the treatment options are and how much they might help the situation.
Mike Richards, DVM 6/13/2000
Peripheral vestibular disorder (syndrome) possible
Question: Our 11 year old Shep/Dob has had two mini strokes during the past three weeks.
She seems to stagger to one side, Not circles. It has lasted maybe 1 hour then she seems fine.
The first time I gave her just one 20 mg pednizone. The second one I gave her 10 mg the first day and 5 for the next two. She seemed a little hiper with 20.
After she snaps out she seems fine. I did check her ears just in case I mistook it for ear infection.
Is there anything else I can do, Have you any thougjt as to the progression of strokes.
I had a litter mate of hers that died two years ago of strokes, only she would have one right after another and didn`t know where she was.She kept going in circles and got worse in a matter of two days, Prednizone did not help her.
Is there anything else besides prednizone for this?
Thank You Linda
Answer: Linda;
Strokes (cerebrovascular accidents) are rare in dogs. There is some chance that dobermans are more prone to this problem than other breeds, though. Dobermans sometimes develop similar atherosclerosis problems to those that affect human coronary arteries, making the possibility of stroke higher, I would guess. Other dog breeds have this condition but much more rarely.
Most of the time when there are intermittent episodes of neurologic signs in dogs there are other causes. One of the more common problems is hypoglycemia (low blood sugar) in older dogs with pancreatic tumors that produce insulin. Other problems that have been reported to cause this sort of problem in older dogs include cardiomyopathy (another problem associated with dobermans), brain tumors, parasites and bleeding disorders. Both shepherds and dobermans have higher incidences of bleeding disorder problems than most dog breeds, although they usually show up at younger ages. High levels of lipids (fat) in the blood stream might potentially cause this problem, too.
Another problem that is common in older dogs is peripheral vestibular disorder (syndrome). This causes balance problems and most pet owners assume their pet has had a stroke when they call us after seeing this problem. It usually comes on quickly and recovery takes several days but some dogs seem to have short episodes of problems that are recurrent. There is a characteristic eye movement, called nystagmus, associated with this condition that produce rapid eye movements from side to side, up and down or even in circles.
Your vet can help you determine if there is an underlying disorder leading to the symptoms you are seeing. I really think it would be a good idea to at least rule out hypoglycemia and peripheral vestibular syndrome and to listen to the heart to try to start to rule out cardiomyopathy problems.
Hope this helps some.
Mike Richards, DVM 5/4/2000
Question: Hi Dr. Mike,
well, what a month. first thrombocytopenia/ehrlichia, now my other dog had what i thought was a stroke. turns out to be vestibular.
i noticed some strange things happening for about a week or two before the onset of vestibular (sure looked like a stroke or seizure to me). first, she kept having sort of unprovoked kicking from one of her hind legs when laying down, and this has happened for about a month. then, i noticed that she very suddenly/severly stumbled on at least four occasions for about 5 days before the main "seizure" like event. then the day before the "event", she had a bath and she wouldn`t stop trembling. at the time i thought she was cold which didn`t really make a lot of sense.
monday night (6 days ago) she suddenly had a violent "seizure" like thing...she vomited (she had vomited once before on sunday and had diarrhea for about 4 days prior) and hit the floor on her side and was just sort of writhing violently on her side with her paws curled in towards her...it was AWFUL. she seemed really out of it when she finally stopped. i ran her to the vet and they saw the classic thing with her eyes shooting from the right violently to the left (nystal...something). i stayed with her all night while she was on an i.v. as well as mezecline? and dexamethazone? (all drugs are recited from a questionable memory of drugs, sorry). they found a severe ear infection and a ruptured ear drum. so she is now on 750mg cephalexin b.i.d. (she`s 62lbs) she couldn`t sit up or stand on her own for two days, but now can hobble around and is very fiesty and trying to walk everywhere even though she`s so unstable still. we have a harness on her and try to help her around.
she is still having those trembling things, though, much like the day before her "seizure."
is the trembling normal? it`s like a tremble/shudder when you are really cold. also, will she have any more of those "events?"
the vet was worried that it may be a brain lesion because there was very slight palsy on the left side of her face and because of the signs i mentioned earlier since she says that vestibular normally comes on without any warning and she was worried that the stumbling could indicate a brain lesion.
wouldn`t the stumbling occur if she had a severe infection?
one last thing...i just got her bloodwork back from the lab to test for ehrlichia since i was concerned because my other dog has it. she has tested positive for E. canis. is there any chance there is a relationship here? thanks very much, sue
Answer: Sue;
Video: Exercises For Idiopathic Vestibular Disease
I think that there is some chance of a brain lesion with the signs you describe but I also think that there is a good chance that this is an inner ear infection causing the nystagmus and other signs of vestibular disease. Infections in the inner ear region are more likely to be associated with facial paralysis than peripheral vestibular disease is and the onset of signs can be more subtle and the recovery from them may last longer than the signs seen with vestibular disease. In some cases there are lifelong residual symptoms, such as a head tilt or slight balance problems associated with inner ear infections. If there is a brain lesion it is likely that you will see a progression of signs over the next few weeks to months, rather than progress towards recovery.
X-rays sometimes show inner ear infections pretty well but often they are not conclusive for this condition. It is actually pretty hard to conclusively prove an inner ear problem exists so most of the time when there is a high degree of suspicion it is just as well to treat for the possibility that the problem exists. The antibiotics are the way to treat for this possibility so your vet is probably considering this possibility already.
I don`t know of a relationship between ehrlichiosis and vestibular disease or inner ear infection.
Trembling of one or more legs is sometimes a problem in older dogs and can occur due to pain from arthritic or other joint disease, spinal problems, hyperadrenocorticism and sometimes for no apparent reason. If an underlying problem is not discovered I do not know of a consistently effective treatment for the trembling problems. Vestibular disease may make this problem more apparent due to the added strength required for constant correction of balance problems which would impact on most of the known causes of trembling. The loss of balance coordination may also be a primary cause of trembling but I am not sure of that.
Hopefully you will see continued progress but if there are setbacks it might be a good idea to ask your vet about ruling out inner ear infection as a possible cause of the symptoms seen.
Mike Richards, DVM 3/15/2000
Idiopathic vestibular syndromeQ: Hi I have already found your site to be valuable and this is the first time I have accessed it. I would like to subscribe. please send me the info-. I am dealing with an acute problem with my dog along the lines of idiopathic vestibular disease. My concern is that the onset was precipatated by medications and advantage. I did not see much mention of toxic substances. and if any other investigations have been done. I am an acupunturist and midwife and have some ideas.
A: Janice;
Idiopathic vestibular syndrome occurs fairly frequently in older canines. I am not aware of a correlation between it and any of the medications used on a chronic basis. There is a tendency for disorders that occur randomly to be associated with medications that are given on a regular basis.
If a disease occurs randomly in the population then it should occur with approximately the same frequency on any day of the month. If a medication is given on the first day of the month it will usually be blamed for any reactions that occur for the next 4 or 5 days. Just to make the math easy, assume 30 days in the month. This means that 1/6 (about 17%) of the time the random cases of a disease that just happen to occur on the days near the time a medication is given will appear to be due to the medication. So a lot of people will assume that the medication may have caused the disorder. When the rate of occurrence of a disorder is greater than would be expected, then the medications should be suspect. This does not appear to be the case, at the present time, with the monthly flea prevention products. Since the reporting system in veterinary medicine isn`t very good it is almost impossible to say that a reaction to medication is not a possible cause of almost any disorder of unknown origin, though.
There are toxins that can produce signs that overlap those of idiopathic vestibular syndrome, especially organophosphate insecticides.
Video: Vestibular Disorders
If you have concerns about the possibility of a reaction to Advantage (TM) or any other medication is it worth asking your vet to report your suspicions to the manufacturer. If no one does that, a correlation between the medication and the disease may never be established, even if one exists.
Mike Richards, DVM
Q: Dear Dr. Mike, Our 8 year old Golden Retriever, Bonnie, has begun exhibiting signs of what our vet defines (over the phone) as "vestibular." Does he mean peripheral vestibular disease and if so, where can I find information on this? Bonnie went under anesthesia for teeth cleaning and when she came out of the anesthesia she seems to be worse. Walking in circles, banging into walls, stepping on our feet, unable to walk down stairs, etc. Could the anesthesia have made it worse? (I noticed some slight symptoms before she went in for the teeth work). Thank you for your help.
A: Vestibular signs are those relating to balance. Vestibular disease can occur if there is damage to the inner ear, the nerves running from the inner ear to the cerebellum or the cerebellum itself. It is necessary to determine which of these is affected in order to make a diagnosis but the most common vestibular disease of dogs, by far, is peripheral (idiopathic, geriatric) vestibular syndrome.
I think that anesthesia can make any vestibular disease worse temporarily because all dogs are disoriented after anesthesia. Dogs with a vestibular disease have to have a harder time regaining their orientation.
Hopefully things are better now, but if not, please contact your vet and discuss this further.
Mike Richards, DVM
Peripheral Vestibular Syndrome
Question:Mike, Our 5 year old Golden Retriever has been diagnosed as having Vestibular Disease. We asked the vet, if she would get better....and the response was "in about three weeks". We have noticed...good days and bad days. She will run into stationary objects, fall over backwards when standing on her hind legs and seems to be aware that she has a problem. .(now cautious). We have also noticed a weight gain.(This could be due to less activity for the dog).The bloodwork was negative. The vet thought that the dog was young for this disease.
My questions: 1) Is there a cure? 2) Will she get better? 3) Will she learn to compensate for her lack of balance? 4) Will this shorten her anticipated lifetime? 5) If not vesitbular...what else could it be and what should we be watching for?
Answer: There is a syndrome, variously referred to as peripheral vestibular syndrome (the current "preferred name"), geriatric vestibular syndrome and idiopathic vestibular syndrome. This disorder is more common in older dogs and thus the name geriatric vestibular syndrome -- but it can occur in middle aged dogs, too, so the name was changed. Idiopathic just means "happens for no known cause" -- so it is a good name but not the preferred one. It does sum up the situation well, though. For some reason dogs can suddenly develop vestibular disease. The problem seems to be due to inflammation in the nerves connecting the inner ear to the cerebellum (which controls balance and spatial orientation). It usually lasts between a couple of days and three weeks. A few dogs have residual signs beyond this time, such as a head tilt. This disease normally affects dogs that seem normal up until the signs appear. Then there is sudden loss of balance with many dogs unable to even stand up. Rythmic eye motion known as nystagmus is usually present. Dogs may be nauseous from the "sea sickness" effect of vestibular disease. Most dogs will not eat or drink unless hand-fed or given water by hand because they have a hard time with the fine motor movements necessary to eat or drink from a bowl. As long as they are nursed through this condition almost all dogs will recover. There is no known treatment. Some dogs do have relapses but most do not.
Peripheral vestibular disease can be confused with anything that will cause cerebellar damage or inner ear disease. Inner ear infections are probably the most common cause of similar symptoms and if recovery does not progress satisfactorily it is a good idea to do whatever testing seems necessary to rule out inner ear problems, such as ear examination and X-rays. Cancer affecting the cerebellum, the peripheral nerves to the cerebellum or the inner ear can cause similar signs. In golden retrievers lymphoma is a common cancer problem that can cause CNS signs. Trauma is a possible problem that could be confused with peripheral vestibular syndrome if brain damage occurs. Granulometous meningoencephalitis (GME). Infarcts (blood clotting leading to lack of circulation in part of the brain) occur in some dogs. If the damage to the brain is minimal then recovery may occur quickly. If the damage is severe, recovery may not occur at all. I do not know the incidence of infarcts affecting the brain in dogs but I think it is pretty low.
Even when dogs do not recover fully from peripheral vestibular syndrome they normally have a good life. They adjust to residual problems like head tilts and do not seem all that bothered by them. If progress towards recovery is not evident, then the other disorders mentioned above need to be considered.
Mike Richards, DVM
Dog shaking symptoms