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Vestibular Disease
Vestibular disorder in Golden
Geriatric vestibular syndrome
Peripheral vestibular syndrome in Golden
Peripheral vestibular disorder possible
Vestibular problems
Idiopathic vestibular syndrome
Vestibular disease
Peripheral (geriatric) Vestibular Syndromealso see GME
also see Geriatric Dog
also see Neurological Problems
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-
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
Q: 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.
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
Last edited 12/05/02