Vestibular Disease in dogs - dog strokes

Vestibular Syndrome – strokes in dogs

by Martin Jones MA VetMB MRCVS on January 25, 2011

My twelve year-old collie, Juno had an attack of Vestibular Syndrome this week. These are what we used to call Strokes, but advances in imaging and investigation have led us to realise that they’re not quite the same, even though they appear just as suddenly and with some of the same symptoms.

Dogs can and occasionally do have Strokes, but they tend to be less serious than in humans. In humans, Strokes – or Cerebrovascular Accidents – refer to a bleed in the brain, so that an area loses its blood supply and is starved of oxygen. Damage quickly becomes irreversible and we all know how variable and tough the aftermath can be, for the sufferer and carers alike. Dogs can, rarely, go through the same events, but are more likely to have an episode where, instead of bursting, the blood vessel spasms and shuts down for a short period. Whilst there can still be damage, recovery tends to be quicker and more complete.

Juno

Vestibular events are slightly different again, but often something of a mystery. The vestibular system – the inner ear – is about balance and so problems lead to classic signs of dizziness. There is staggering (ataxia), flicking of the eyes (nystagmus) from side to side, up and down or even rotationally, and a head tilt to one side. Facial nerve tics or paralysis are sometimes present. Motion sickness can be obvious, or may present as reduced appetite, which is hardly helped by the confusion and anxiety that most patients experience.

Juno had a sudden onset of these symptoms about four days ago, accompanied by a bit of leaking urine, and has been gradually improving for the last 48 hours. As of today, she’s not too bad when walking in a straight line, but getting out of her basket is still a bit hit and miss and sharp turns tend to become handbrake slides. She’s still eating her food, but for the first time ever seems full up before the bowl is empty. Life isn’t all bad, though – her basket has been moved in front of the fire and with the TLC she’s getting from the whole family, she’s more likely to die of happiness than from dizziness. And hopefully, over the next few days to weeks, she’ll gradually return to normal.

Vestibular disease can have a number of causes: infections, from the brain itself or from the middle ear, cancer, poisonings, parasitism, immune disorders, occasionally as a sign of Hypothyroidism (underactive thyroid), and commonly as an idiopathic event. Idiopathic basically means that we don’t know the cause, but know that it isn’t due to anything else. Idiopathic Vestibular Syndrome is something that comes on unexpectedly, for unknown reason, and then usually goes away on its own, albeit often with some residual signs like a minor head tilt.

Currently, it appears that Juno’s condition is the idiopathic version, and not due to something nasty lurking underneath, or else possibly thyroid-related, which is easily treated with thyroid supplements. Juno’s not otherwise ill, has no history of ear disease (although it can sometimes be silent), and doesn’t have any progressing symptoms. I ran some bloods the day after it all started, which were entirely normal. However, if she should relapse, I’ll be looking at more investigation, which may be a lot more complicated.

Testing for brain disease can be very difficult: to make a definitive diagnosis, we generally need to look at sampling the fluid around the brain – the Cerebrospinal Fluid (CSF) – and/or performing an MRI. Both require a general anaesthetic, are potentially risky procedures and can be very expensive. Right now, for Juno they’re not a priority as things are looking OK, but remain as options.

In the meantime, I’m supporting Juno as much as possible, whilst waiting for the results of thyroid tests. Even though we don’t usually know the cause of Vestibular Syndrome, there are a number of useful drugs which are commonly used:

Most vets will use anti-sickness drugs, to combat the motion sickness.
A fair few use steroids, a common treatment for neurological conditions, particularly when a decision has been made not to investigate further.
Some vets will use Vivitonin, which is often used to enhance blood flow to the brain and which we’re using more and more for heart disease. Whilst there’s no solid evidence that it works in vestibular problems, there can’t be any harm in making sure that the blood supply is topped up.
Sometimes we’ll prescribe a human drug called betahistine, which is used for vertigo, as it’s reported to speed up recovery.
In terms of general boosting of brain activity, there are supplements like Aktivait and Selgian, which are usually used to combat signs of senility in older patients, and essential fatty acids.

Equally, though, nursing and TLC is all-important for these patients:

Reassurance
Palatable and digestible food
Help with movement, but only enough to make up for what’s lacking – if all she needs is a hand under the bum to get up, then she gets it, but that’s all she gets.
Promoting the idea of ‘horizontal’ by providing strong visual cues in the house. Juno’s basket is in front of the wide, flat sofa and thin, tall objects have been removed. In severe cases, horizontal masking tape on the walls and doors may help
Frequent trips to the garden for balance and urination
Keeping pathways through the house clear of clutter, to reduce bump hazards
Gentle and short walks in straight lines
A nappy, to reduce the anxiety of leaks: purpose-made wraps are available for longer term conditions, but for now we’re using large disposables with a hole ripped for her tail.

It’s important to note that because, by definition, we don’t know what causes Idiopathic Vestibular Syndrome, treatments and care are largely based on common sense and logic. It’s true that if left alone, many patients recover by themselves, although this can take several weeks, but anything which reduces the recovery time, and makes it more bearable, must be a good thing. So far, Juno is responding well and I’m hopeful that we’ll be out of the woods before too long, but in the meantime I’m giving her every chance that I can.