Vestibular Attacks

Mrs. Stenner woke up in the morning to the sound of something crashing around in the dining room. When she got up to investigate she saw her 12 year old lab mix, Jordie, stumbling around under the table, seemingly unable to get himself untangled from the chairs. After she helped him out into the living room she could see that he was still having trouble. He kept tipping to one side and falling over and his eyes looked like they were rolling around in his head. Just yesterday evening everything had been completely normal with Jordie. He had dinner, went for his usual walk, and even played a little fetch with a stick they had found on the way. Now it looked like he was having a stroke, and Mrs. Stenner was worried sick about her pet.

When he came into the office Jordie was able to walk, but just barely. He was twisting his head so that his right ear was pointing to the floor and would fall over if he moved too much. His eyes were bouncing from side to side in a rhythmical fashion, and he had vomited in the car on the way in. After a complete exam I was able to tell Mrs. Stenner, much to her surprise, that there would probably be some good news here for Jordie.

Jordie was most likely having a problem that we occasionally see in older dogs called a geriatric dog vestibular attack. The vestibular system is the name of the complicated neurological pathways that allow us to sense where our bodies are in space and keep our balance without having to consciously think about it. Those pathways connect sense organs deep inside the inner ear, the brain, and the muscles of the eyes and the skeleton. The symptoms of a vestibular attack come on suddenly and without warning, like a stroke, but the cause of the attack does not appear to be a blood clot or a bleed in the brain. An infection or tumor deep in the inner ear or in certain parts of the brain can cause the symptoms of a vestibular attack. Both of those reasons are relatively rare in comparison to the most common reason, which is called “idiopathic” -- an erudite sounding term for “we don’t know why.”

Affected dogs are getting erroneous signals sent to their brain from their inner ear sensors that are insisting that they are falling over when they are not. Tipping the head so that one ear is up and one is down seems to help satisfy the mistaken sensors and relieve some of the sense of falling. The eye twitching is a result of part of the neurological reflexes involved with balance and vision going haywire as well. Many dogs vomit or refuse to eat, most likely from a sense of vertigo and motion sickness that can be part the syndrome.

The vast majority of dogs that have an idiopathic vestibular attack will improve dramatically within 3-5 days. Although most will return to completely normal function, some will be left with varying degrees of a permanent head tilt that usually doesn‘t cause problems. Cases that don’t improve quickly are more likely to be due to brain tumors or infections.

Veterinarians get to claim credit for fixing the problem when we dispense medication and then the patient gets better, so sometimes we will send home prednisone, a powerful anti-inflammatory medication that works particularly well in the brain and spinal cord, with the hope that it will reduce a possible cause of the problem and speed recovery. Studies have shown that when given prednisone for a vestibular attack most dogs recover in about 4 days, and when not given prednisone for a vestibular attack most dogs recover in about 4 days. It can be hard for us to sit on our hands and wait, but tincture of time is really the treatment that is needed if causes like infection and tumors have been eliminated. Anti-nausea medication can help with the motion sickness when it is so severe the dog can’t eat or is vomiting.

Good news was not something that Mrs. Stenner was expecting when she came in with Jordie, but sure enough, he was back to his walks in the park and stick chasing before the week was through and you would never have guessed that this scary episode had ever happened to him.