Hey there, pet parents. Have you ever had an older dog that was perfectly normal one minute, and the next minute they can't stand up, are falling over, and have a dramatic head tilt? It's an incredibly scary and disorienting experience, for both you and your dog. This is the classic presentation of Idiopathic Vestibular Disease, often called "Old Dog Vestibular Disease." While it looks like a stroke, the great news is that it's usually not as serious as it looks.
What is the Vestibular System?
The vestibular system is the body's balance system. It's what tells the brain where the body is in space, and it's responsible for balance and coordinating the movement of the head and eyes. The vestibular system has two parts:
- •The Peripheral part: Located in the inner and middle ear.
- 1The Central part: Located in the brainstem.
What is Idiopathic Vestibular Disease?
Idiopathic Vestibular Disease is a sudden, non-progressive disturbance of the peripheral vestibular system. "Idiopathic" means we don't know the cause. It's a diagnosis of exclusion, meaning we have ruled out other causes of the signs, like an ear infection, a tumor, or a problem in the brain.
It most commonly affects older dogs, which is why it's often called "Old Dog Vestibular Disease." It comes on very suddenly and can be very severe for the first 24-48 hours.
Spotting the Signs of a Vestibular Episode
The signs are sudden and dramatic:
- •A Severe Head Tilt: This is the hallmark sign. The dog will have a persistent tilt of the head to one side.
- •Loss of Balance (Ataxia): They will be very wobbly and uncoordinated. They may be unable to stand or walk, and may roll or fall to one side.
- •Nystagmus: This is a rapid, abnormal, back-and-forth movement of the eyes. It can be horizontal, vertical, or rotary.
- •Disorientation and Anxiety: The dog feels like the world is spinning (vertigo), which is very distressing.
- •Vomiting: The "motion sickness" from the vertigo can cause nausea and vomiting.
It is very easy to mistake these signs for a stroke. While strokes can happen in dogs, they are much less common than Idiopathic Vestibular Disease.
How Vets Diagnose Vestibular Disease
The diagnosis is made based on the classic clinical signs and by ruling out other causes. Your vet will perform a thorough physical and neurological exam to try to determine if the problem is in the peripheral vestibular system (the ear) or the central vestibular system (the brain).
- •Otoscopic Exam: Your vet will look deep into your dog's ears to check for any signs of a middle ear infection.
- •Bloodwork: To rule out any metabolic problems.
- •Blood Pressure: To check for hypertension.
If the signs are consistent with peripheral disease (e.g., a horizontal nystagmus and no other neurological deficits), and there is no evidence of an ear infection, a diagnosis of Idiopathic Vestibular Disease is made. If there are signs that point to a central problem (e.g., a vertical nystagmus or weakness in the legs), your vet may recommend more advanced imaging, like an MRI, to look for a problem in the brain.
Treatment: Tincture of Time and Supportive Care
This is the great news: there is no specific treatment for Idiopathic Vestibular Disease because it usually gets better on its own! The treatment is all about supportive care to help the dog through the first few days while their brain learns to compensate.
- •Anti-Nausea Medication: Medications like meclizine (Bonine) or Cerenia are given to control the "motion sickness" and vomiting.
- •Supportive Nursing Care: For the first day or two, your dog may be so disoriented that they can't stand or walk. You will need to help them get outside to go to the bathroom. Provide soft, padded bedding so they don't injure themselves. You may need to bring food and water to them.
- •Hospitalization: If the dog is so disoriented that they are rolling uncontrollably, or if they are not eating or drinking, they may need to be hospitalized for IV fluids and supportive care.
Prognosis: A Remarkable Recovery
The improvement is often as dramatic as the onset of the signs.
- •Most dogs will start to show significant improvement within 72 hours.
- •They will usually be able to walk and function normally within 1-2 weeks.
- •The one sign that can linger is the head tilt. Many dogs will be left with a charming, permanent head tilt, but it doesn't affect their quality of life.
While it is a terrifying event to witness, Idiopathic Vestibular Disease is a condition that looks much worse than it is. With a little bit of supportive care and tincture of time, most "old dogs" will be back on their feet in no time.
Sources & Further Reading:
- •VCA Animal Hospitals - Vestibular Disease in Dogs
- 1Merck Veterinary Manual - Vestibular Disease in Dogs