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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, when he 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. (The condition plays a role in the new Hallmark movie, Duke.)

Well, I want to shed some light on a much more common and less concerning cause of these and other disturbing signs, something known as idiopathic vestibular disease, in case it is something you ever experience with your own geriatric dog.

Idiopathic (meaning unknown cause, think: idiot) vestibular disease is a syndrome that looks really, really bad, but usually gets better all on its own with little or no treatment.

The vestibular system
The vestibular system 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 have some combination of the following signs:

These videos show a dog with mild, but very typical, vestibular signs and another dog with more severe signs.

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. These can include (yes) a brain tumor, an inner ear infection, inflammatory disease or sudden bleeds into the brain—to name a few. 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.

Wait-and-see approach
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 (pictured below) 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 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. 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). 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 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 this time frame, with the pet returning to normal in 7 to 14 days (although in some dogs, a head tilt will still persist).

It should also be noted that this 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.

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Veterinarian Shea Cox has enjoyed an indirect path through her professional life, initially obtaining degrees in fine arts and nursing. She later obtained her veterinary medical degree from Michigan State University in 2001 and has been practicing emergency and critical care medicine solely since that time. In 2006, she joined the ER staff at PETS Referral Center in Berkeley and cannot imagine a more rewarding and fulfilling place to spend her working hours. In her spare time, she loves to paint, wield her green thumb, cook up a storm and sail. Her days are shared with the three loves of her life: her husband Scott and their two Doberman children that curiously occupy opposite ends of the personality spectrum.

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Submitted by Dave | August 13 2014 |

My 14 yr old Golden Retriever came down with all the symptoms yesterday morning. After a few sessions of vomiting and urinating in the house, I put her on 1 tablet of Dramamine every 6 hours which seems to have calmed her down. However, she did not urninate until the following morning(finally!). Her fluid intake has been sparse. She will eat about 1/8 cup of ice chips every few hours but has shown little interest in her bowl of water or water by syringe. She has had a mild appetite. Most concerning, she still has no ability to get up on her own or even stand without me holding on to her. But she does appear to try and get up using her front legs. She has a heavy lean to the right. I've consulted her regular vet back home (I'm traveling) and one here in a town I'm visiting and both say to wait it out for a couple of days. Should I take her to the local vet and get her on an IV today or wait for tomorrow to see if she's improved (that would be 48 hours since onset of symptoms). Thanks so much for your advice.

Submitted by claire sanford | August 13 2014 |

My 14 year old Pharaoh Hound has had this problem for about 2 months. It started with an ear infection that would not go away, regardless of the antibiotics we gave him. He is now 99% deaf. We give him VertiCalm 25mg per day in the morning for the vestibular disease. If he is really bad in the evening, we will give him another half.

I really did think we were on the verge of losing him. My Wonderful AMAZING Vet told me to give him this and he has been good (just a bit wobbly) ever since.

Submitted by Nicole | August 17 2014 |

Our dog is a sheltie mix and is 14/15, rescued him in 2001. For the past few days he has been vomiting off and on and bouts of diarrhea. Still eating and drinking. Today he fell off the couch and is having a little trouble walking, head tilted a little, jut really seems unsure of himself. Going to watch him for a couple of days and see if he improves and will be giving him dog aspirin and a natural dog calming chew to help him relax and stay still . Hope i am doing the right thing.

Submitted by Lori Shuman | August 24 2014 |

Oh my gosh, my little Maltese just started with the drunken sailor aspect. It has gotten worse and he is struggling to stand. I am supporting him. He has no appetite. He spent 24 hours in the emergency room getting fluids but the vets are young. I have him home and he is so comfortable. I have him in a soft crate with his soft cushy bed. Prior the this onset he was having some vomiting and loose stool. While in the ER he had two episodes, flailing his head around, the vet thought they were seizures. I am not sure. Tomorrow I will take him to my vet for another consult. I am hoping he doesn't have a tumor. The onset was so sudden I am skeptical it is a tumor. Say a prayer for my little guy.

Submitted by Jane | August 24 2014 |

My 13 year old Border Collie suddenly started experiencing the symptoms 6 days ago. (He has never had any Healy problems and only started getting arthritis last year.) He was sick and became very shaky on him legs, I took him to the garden but he had to walk along the fence to balance and he stood in corners for a long time. Took him to the vet the next day and he confirmed it was canine vestibular disease (which started he couldn't tell for sure but hinted at peripheral the most common) he gave him an injection for the sickness and some tablets but could not see ant sign of an ear infection. Snowy has shown a few improvements over a few days, namely walking without assistance sometimes and his eyes not darting back and forth as quick. He sleeps the majority of the day and drinks/eats little. Lately his tilt is causing problems and it's terrifying watching him sleep as sometimes he is inclined to sleep with his head tilted and his eyes darting. It's clearly not a comfortable position and I he doesn't seem to have the strength to move into a comfier one. Has anyone had this problem with sleeping too? If so are there any tips? The other day I noticed he has an infected tooth (it's got green gunk around the gum and I think it'll need to be removed) and has a vet appointment tomorrow. Does anyone think this tooth infection could be a cause of the vestibular disease? Any advice would be greatly appreciated, my family are being quite negative and considering 'the kindest option' But I am still holding out hope for my dog - though my hope a dwindling when he has those 'head tilt sleeps' . Thank you.

Submitted by Tiffany | September 2 2014 |

Dr. Cox, I can't thank you enough for this article. This describes almost perfectly what happened to my 15-year-old dog last night, and we were panicky. Hopeful that this is what it is, but you took a huge load off our chests. So glad this came up in a search--thanks!

Submitted by janet blanchard | September 3 2014 |

My 8yr old English mastiff got into the car last Saturday and he would not get out for his walk, I took him straight to vets expecting him to be put to sleep, he was really bad. Vet said to give him 48 hrs and injected him with all sorts.
We had to carry him in home and bed him down on a thick quilt, he never moved for 24 hrs I had him on puppy pads to soak his wee up and syringed him water. He was bright enough just could not get up.

Day 2 I used a sling to help get him up but he is so heavy I struggled, he was eating cooked meats ( to hide his meds in) but not interested in his own food. It is now day 4 and he is much improved, going out in garden to toilet, he does keep falling over on his front end but gets up after a few mins.
I am so glad I saw all your posts as it has really given me hope, I almost told vet to put him to sleep.... so glad I gave him a chance.

Submitted by Karen H | September 3 2014 |

Thank you...thank you...thank you! My 14 yr old Springer exhibited ALL the described symptoms and shook me to the core thinking he had a stroke. The vet has kept him in hospital for 2 days now and is showing some improvement! His diagnosis was "Old Dog Vestibular Disease". Hope to have my best friend home soon!

Submitted by sue | September 4 2014 |

A question.... Our dog displayed balance issues along with head tilt symptoms beginning 4 weeks ago. An MRI was recommended but we have recently spent a lot on ACL surgery and can't afford that. We opted to treat with antibiotics and prednisone. We saw slight improvement initially but balance and coordination have continued to regress over the past weeks.Prior to making a final decision about ethnicizing, we want to be as sure as we can without the MRI that there may not be another treatable solution.
Here is our issue. When we take her out for a walk she wants to run and can do this very well with no balance concerns. She actually saw our neighbor's cat and took off running after her. When she stopped she lost her balance again.
Is there anything else besides a tumor that she might have???
PLEASE offer your thoughts
Thank you!

Submitted by Mickey | September 6 2014 |

My little mini pin who's almost 16 years old just started walking in circles. I'm very scared but I guess I'll have to go to the vet and see what's going on

Submitted by Jackie | September 6 2014 |

My italian grey hound who is 9 started getting these symptoms about 5 years ago (yes I have had her to vet..i have gone without to get my animals care as any good pet owner should..but I can't afford the huge amount of tests they want to do..we are both disabled now..and still have 2 kids at home..so I see they are not in pain..and it resolved on its own quite fast)....minus the head tilt and I have never seen the rapid eye movement either..she is always sleeping when she wakes up, has trouble standing, clumsy gait, and then has to pee a bunch and then vomit...her symptoms are completely gone within 15 min...she gets it about once a month..now what is weird our other dog who is 7 he is a rat terrier has the same symptoms 2 times..now..does this seem like they have it even though there is no head tilt...and no noticeable rapid sure movement..weekday do you think?? Any he'll is so appreciated..thank you..

Submitted by Hannah | September 15 2014 |

Thank you, Thank you for this page. I sat up all night with my 15 year old dog Harry, crying and saying goodbye. He had vomited all over the house, staggering, falling and SAD. The next morning, he mentioned I was late with his breakfast and has been rapidly improving ever since!

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