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Canine vestibular disease: making sense of a world upside down
"Doc, I think my dog had a stroke! She is falling over and can't get up. She is holding her head sideways. She vomited twice. What do I do?"
Of course the first thing I tell these concerned pet owners is to immediately bring the dog to our clinic for evaluation. What I usually find is a dog that is having a problem with its vestibular system. What is the vestibular system? How does it go so wrong?
The vestibular system is the balance system in dogs (cats also have a vestibular system but it is not affected nearly as much as dogs so this article will focus on dogs). There are two parts: the peripheral component and the central component. The peripheral component includes the structures of the inner ear (the cochlea, vestibule, semicircular canals and eighth cranial nerve). The central component includes the balance center in the brain — the cerebellum and a portion of the medulla oblongata. Whether the peripheral or central component is affected the balance is way off.
Although infections, tumors, glandular disorders and certain medications can lead to this condition, the most common cause is actually something called idiopathic vestibular disease. Idiopathic vestibular disease is most common in older dogs so it is also known as old dog or geriatric vestibular disease. The exact trigger in these cases is unknown.
This is good and bad — good in the fact that one could run every test under the sun (bloodwork, X-rays, CT scans, MRIs, spinal taps, etc.) and they would all come back normal or negative. It is theorized that there is a problem with the lymph ducts (similar to a human condition called Mèniére's disease). Arteries bring oxygen and nutrients to organs. Veins take away carbon dioxide and waste. And finally the lymph ducts are the vessels that bathe the organs of the body in fluid. It is felt that changes in pressure within these ducts irritate the components of the inner ear and lead to this. Idiopathic vestibular disease is bad in that there is no specific way to treat these cases except to nurse the patient through the episode.
The signs of vestibular disease (regardless of the cause) are related to abnormalities in maintaining normal balance. The dog will hold its head to one side, sometimes fall over, vomit (due to motion sickness), and have an abnormal eye movement called nystagmus, which is when the eyes flick back and forth. Nothing is wrong with the eyes per se, but rather it is the eyes trying to compensate for the abnormalities in the balance center.
The signs do come on suddenly and patients that have suffered from idiopathic vestibular disease also can have both residual signs, as well as repeat episodes (hence the analogy of a stroke). These episodes do usually resolve within 24 to 72 hours (at least to the point where the patient can eat and drink) but during that time some patients need to be hospitalized for IV fluids and medications.
So remember, if your dog suddenly can't tell which way is up it is not the end of the world. Just make sure to bring him or her to your veterinarian right away.
Dr. Kearns has been in practice for 13 years and is pictured with his son Matthew, as well as the newest member of the family, Jasmine, a Labrador retriever.