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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 Christina Yutzy | May 14 2014 |

My 12 yr old lab is going through this right now. This is his second episode. The first scared the crap out of me. He couldn't walk, stand, or sit for over 4 hours, even though he kept trying to. I didn't notice the eye movement the first time because I was so worried but he is doing it this time. The first time he didn't throw up but he did just now. He is drooling a lot and his nose is running too. Over an hour in to this and he is trying to relax. Hopefully it will blow over soon. I feel so helpless! Guess it's time to make a vet appt.

Submitted by Holly | May 19 2014 |

My Collie mix, Sissy, had the Old Dog Syndrome the day after Christmas last year and recovered after less than a week. It's May now and she has the same symptoms but less severe. Her eyes aren't darting back and forth and she is walking better (after her initial drunken sailor onslaught). She is still unsteady, but she can walk without us helping her on the leash. The emergency vet put her on Prednisone to help with inflammation and said it could make her stomach queasy. This is the fifth day she's been like this. This morning she threw up all of her dinner from last night. She's shakes uncontrollably and it pains me to watch. The vet said that by the end of this week we'll know if she's going to recover or not (based on if she shows improvement), otherwise, we're going to have to make a very hard decision. My dad said we'll see how she is tomorrow. If anyone has had a dog who has had this twice in their lifetime, please let me know. I want to do the best we can for Sissy and seeing her like this makes me so sad.

Submitted by Jules | May 24 2014 |

Our 14 year old doxie just started with the exact same symptoms, it took us less than 2 days to recognize what was actually happening as her head started tilting to the left with dizziness, when walking. May 12th we took her to see the vet and she knew exactly what was going on and showed me what was going on with her eyes. She has been on Meclizine 12.5mg. 1/2 tablet every 12 hours and she is still walking/staggering around and wagging her tail when we pick her up. We see her symptoms get worse as the 12th hour approaches. Her appetite is ravenous for a 12 lb mini. She has not been vomiting. I do take time to massage her neck and we help her up on our now lowered bed and help her get down when she barks to get down. We are just soaking her up as we usually do. We will be returning to the vet soon to have her ears checked once again as I have been putting in enzyme ear drops 2x day as prescribed. She has had dry eye since she was born, the left eye being worse, now it takes all my strength to hold her and open her eye since she has had this, another issue to be discussed. We are not giving up on her. We were told her head will probably remained tilted for the rest of her life, but that is okay with us. Don't give up on your pets, they need you as you do them. If they still have quality of life, support them and love them through this.

Submitted by kari | May 26 2014 |

I am SO thankful I found this article! My 12ish yo aussie is experienceing this right now. Symptoms started yesterday (of course on a sunday with today being a holiday) but she seems a bit better today. She's not really eating, but drinks fine and pottied outside with no assistance. I plan on calling the vet tomorrow to see if she needs to be examined. crossing my fingers she feels better more each day and will pull thru it like a champ :)

Submitted by Kim Kello | May 28 2014 |

My dog is 13 1/2. It has been five weeks since the sudden onset of this condition. While she has improved dramatically, she still has not fully recovered. I am trying to be very patient because I thought I was going to lose her due to the severity of her symptoms. It is a long road and I am still hoping for a full recovery.

Submitted by SD Dog Lover | June 3 2014 |

A little over two weeks ago we came home to find our almost 15 year old yellow lab in the corner of the room, unable to stand and with what we now know is nystagmus. We were afraid she'd had a stroke, and took her to the vet fearing we'd have to make the difficult decision to euthanize her. We were so relieved to hear the vet tech say that it might not have been a stroke; she looked like she was exhibiting signs of Old Dog Vestibular disease. The vet agreed that it looked like Old Dog Vestibular Disease, and after two nights in the hospital for treatment and observation, we took her home to nurse her back to health. After one day, she could stand on her own; after two, she could walk without support. Her appetite improved and she's been eating more than she has in years and put on some much-needed weight. We've completed her course of antibiotics and she's doing pretty well overall. However, in the past few days she has been pacing at night and it's difficult to get her to settle down. A friend who suffers from vertigo said it took her several weeks after her first episode to lay down because the room would spin. Is my dog unable to lay down comfortably because she is still suffering? Should I be giving her 25 mg Meclizine (which was prescribed by the vet to use as needed - but which we've already used up)?
She's eating well, going outside to potty and loves getting affection -she just can't seem to settle down and I'm not sure what to do.

Submitted by Dorene Willet | June 3 2014 |

This just happened to my 14 year old border collie mix. Thank you SO MUCH for this information. We thought he had a stroke, and were waiting over the weekend to decide what to do. Fortunately a friend sent me this link, as the same thing had happened to her dog in the past. I am VERY happy to say that has is recovering quite nicely. He is now 5 days post his initial presentation , and is 75% resolved, although I am still hand feeding him. I am sure this information will save the lives of our dear companions. Thank you again.

Submitted by Shelley | June 4 2014 |

My 14 year old Golden is still recovering from her second bout (her first being about 4 months ago). It's take a bit longer the second time than the first, but she is finally able once to go up stairs by herself (I walk behind her just in case). Down is a bit of a challenge, but I have been putting a beach towel around her tummy and holding the ends over her back so I can keep her from landing hard if she stumbles.

Submitted by Jennifer | June 5 2014 |

My almost 13 yr old German shorthair pointer has an old dog vestibular attack about once a month for the past year. He improves with 24hrs or less but it is very scary to watch. Have you heard of a dog having episodes with this frequency? He is otherwise in great health and most days could outrun us all.

Submitted by Bill Clarke | June 10 2014 |

I am really glad I found this page - first one I clicked on after contacting emergency vet early Saturday morning. My 14ish year old Rottweiler X - Kaiser - appeared to be having a stroke - couldn't walk, eyes going rapid side to side, head drooping, severe panting - and as soon as I told this to the veterinary nurse she mentioned vestibular syndrome as a possibility. Whilst preparing for journey to the vet, we looked on this page and gained hope/confidence about talking with the vet.
The emergency vet was very knowledgeable about vestibular and proposed a steroid injection and sedation if needed, then "wait and see". At 4 PM that day we called for an update and he was up and eating - but walking like the proverbial drunken sailor. He stayed in the vets for one night and next day he was able to come home - walking hesitantly at first but through the day got more confident and went up/down small steps unaided.
On Monday we took him to our regular vet - he has had two dogs himself who suffered from this and gave good simple advice to keep Kaiser safe and sound whilst recovering. Stair guard, keep lights on for first couple of nights, keep room layout constant etc …
Kaiser takes sweeping routes with many corrections to get to his objectives – but he gets there and is improving each day. Went for 2 walks - on lead with harness to help steering - with my two other dogs today, and lead all the way.
Thanks for all the info – helped our family maintain a bit of sanity whilst waiting for news.

Cheers

Bill Clarke
Leicester,UK

Submitted by Hilda Avello | June 11 2014 |

I just got back from dropping my terrier mix Betsy at the Vet Emergency Hospital. Out of the blue in tge early morning hours, she came to my bed trying to get under it. It wasn't a usual situation b/c she was rolling and moving her legs in a wild manner. I put her on the bed, and she held onto me real tight. She had a head tilt and her tongue hanging out. She is 12 and a healthy dog except for a sensitive tummy and she was being treated for pneumonia. She was miserable with the antibiotics and was beginning to refuse her food. Now this. I don't know anything about this except for this article, your posts, and the vet's explanation. Would love feedback if you have any to give.

Submitted by Joe Foster | June 20 2014 |

Our dog Bessie (mongrel/collie mix) is around 17 years old and some of the symptoms you mentioned began appearing over the last 2 months. We took her to our local vet and they told us it was an in ear infection and we were given antibiotics. After the weeks course of tablets she seemed much better than before, not losing balance/falling over as much but she still has a prominent head tilt. It doesn't help that she is almost completely blind! (though she still manages to find her way)
She is still extremely healthy for her age, loves going on walks, eating, lumbering up to see us when we're home from work etc. Hopefully it's nothing serious but if more symptoms start appearing again we will take her the vets to try find a way of treating it.

Submitted by Tracey Foy | June 21 2014 |

Hi, I have an 11 month old mix breed pup. She is currently showing these symptoms. She is extremely trembly with it. She has been tested for toxins, epilepsy, liver shunts, meningitis etc she has been ill now for 6 days. On Thursday mort I was asked to consider putting her out her misery as she lost strength in her Fri t legs and was on her face when trying to stand. I asked to wait until the end of the day. She then picked up slightly. Gained some strength back in her legs and could hold herself up. I have her home for the weekend. I've to keep a close eye and administer her meds. Back to vet Monday. Basically could this disease affect a pup? Or is it really only for old dogs? Thank you

Submitted by Janet Upton | June 24 2014 |

My 13 yr old Ger. Shepard just had an episode that has been diagnosed as a ger. Idio. canine vestibular event. Scared the day lights out of me. Immediately thought stroke or brain bleed (have experienced these before with previous dogs). Immediately got help, put in car and were off to vets 30minutes away. Took 2 of us with slings to get her in car. By the time I got there and got help to get inside she had recovered enough to walk on her own. All other symptoms had disappeared. No head tilt, no unusual eye movement, moving normally-didn't even wait for me to help in car.
This is a very healthy 13 yr old. Regular check ups, CBC + chem panel done 2X year. No signs of skeletal, joint or CNS problems. So my question: although I know this is difficult to define, in your experience can I expect her to experience other occurrences of this on a regular basis or if maybe with a such a short and apparent full recovery--a little more than an hour--it could be a rare and hopefully one-of event.
Thank you for your informative web site.

Submitted by Jennifer | June 24 2014 |

I have a 6 yr old Maltese who developed all these symptoms right after having teeth pulled. She's been on 3 different antibiotics, ear drops, pain meds, meclizine, etc. We are going on week 4 now with no relief. She can barely walk and when she does, it's in a circle and she stumbles a lot. She screams out for no reason at all, more so when I have to pick her up to take her outside or up and down stairs. She's not herself. Her eyes aren't hers anymore. She shivers constantly and just sits staring off into space. I am so worried about her. I feel like maybe there is something that the docs are missing. She has seen 2 vets in the last month and they both say it's vestibular, but something just doesn't feel right. Any thoughts?

Submitted by Christine | June 26 2014 |

Our cricket is a 13 yo cocker spaniel and had a bout of vestibular last Friday - we recognized it was either that or a stroke but thankfully IVD - it happened in front of is and like a vertigo sufferer I lifted her in the car to take her to the vet and held her firmly with the pads of her paws flat and for some reason firmly pressed the bridge of her nose and that seemed to calm her till we got her to the vet. The vet diagnosed IVD and gave her a cortisone injection and maxolon (we are in Australia). We kept her at our bedside in a children's pen around her bed with and kept the light on so she could focus if she tried until she went to sleep. We gave her 10mg of phenurgan and that helped her relax. She improved the following day but that second night had another attack and her head moved from one side to the other. Not as bad though as the first episode. Back to vet for a top up of cortisone then a course of prednisolone (yes adults take this for vestibular neuritis but in smaller doses) and a course of nicergoline which vet said is something that helps the heart pump more blood to brain and may have no effect whatsoever but we were told to try it (note this is I advisable if dog is on any heart medication). For two days we bring water to her but she certainly knows when food is round and the steroids are giving her a huge appetite and because we are giving her water she is drinking well. She is still penned at night but she is happily alert whimpers to let us know it is potty time and that she's had enough sleep around 7am. now a week later apart from a tilt to her head and a slight weakness on one side she's fine to run around although we are very careful not to let her go up and downstairs and pick her up slowly with no sudden movements when she needs to be lifted into car etc . Her eyes are bright and she happy to be stroked and indeed parts you to stroke her but she doesn't like being touched on her head and I notice she is putting her head to rest more on her pillow. Today she chased a ball for the first time and had a small walk around the block . Long live my darling cricket - so glad we still have you - when she is off her steroids we will begin gentle massage on her neck.

Submitted by Lauren falco | July 3 2014 |

My dog is 14 year old diabetic. I can't do any surgery, she wouldn't survive, should we get diapers? And is there anyway to help her with this without surgery? Any help appreciated

Submitted by Charlie | July 5 2014 |

Our 5 year old Am.Bull X is just recovering from IVD. She never had head tilt but drooled severely. Which oddly enough never did any other time. She ended up staying in the hospital for a night and day, on IV as nothing was staying down and then she stopped eating. We see improvement every day, still very slightly unsteady and no blink to left eye, but no vomiting, drooling stopped and she has her appetite back. Thank you for this information. I wish I would have seen it earlier in the week, I was very scared for her. We are soo pleased to have her returning to her happy care free self.

Submitted by Emily | July 7 2014 |

My 13 year old black lab had his first episode a couple of months ago. He finally mostly recovered and then had another episode yesterday. Is it very common for this to recur? I worry a lot about his quality of life at this point.

Submitted by PATRICIA A. GRAHAM | July 8 2014 |

My 14-yr old Mini Schnauzer (birthday this week!) was diagnosed with idiopathic vestibular disease yesterday and put on medication to control her vomiting and diarrhea (and vet suggested anti-nausea medication which I'll pick up today). Her symptoms began suddenly about 4 days ago, head tilt, nystagmus, trouble walking, general confusion, vomiting and diarrhea, general confusion, etc. She refused only one meal the other morning so appetite is okay and she's drinking plenty of water. The vet ruled out ear infection, and does not believe a brain tumor is the problem - although admits we should do a wait and see. My question is whether or not this disease also cause deafness or partial deafness. I ask because it appears to me that Tee Gee, my sweet dog, is not hearing me. I believe that I'm seeing some improvement already with her general symptoms for which I'm grateful but I'm confused about her apparent "deafness." Part of the disease or a separate issue? Thank you for your wonderful site!

Submitted by Nilsa Soto | July 9 2014 |

My dog is 16,his condition is getting worse. It started with simply him doing 360 and now he doesn't walk straight, can't go for walks at all,pees on himself meaning leg no motor, trouble eating, goes roundin circles al the time, no balance, and now he's tilting his head. It's their any relief? I have to give him water cause he won't eat and takes for ever to eat.

Submitted by Kim Nuzzo | July 10 2014 |

This article is very helpful. My senior Airedale was diagnosed with this disease and her symptoms are exactly what is described above.

Submitted by Laura | July 11 2014 |

My 13 year old polmeranian also exhibits similar behavior by walking sideways. She manages to go to the restroom and eat but her symptoms are less severe. My dog has lost a significant amount of her hearing, I believe she is deaf. Can this disease be due to her hearing loss.

Submitted by ksbdisneydame | July 13 2014 |

Thank you so much for this blog and all your readers comments. It really helped me and brought me comfort. My 12.5 year old Boarder Collie, Daisy, woke Friday morning unable to stand or walk. Convinced that she had a stroke I brought her to the vet for what I thought would surely be her last visit. The vet ran some blood work and did a physical exam. Based on her blood work and her symptoms the vet ruled out toxins and stroke. Not really displaying cut and dry symptoms the vet felt like a wait and see approach would be best and suggested that I give Daisy some Dramamine just in case it was vastibular disease. I watched my dog's condition worsen with every passing hour. After watching her fall down several times while trying to potty in the middle of the night I was convinced that I was being cruel and needed to rush her to the emergency vet to make arrangements to say goodbye. I tearfully turned to the computer for confirmation that I was making the right choice when I found your blog. I took your advice and decided to give her time. I laid down beside my dog to tell her that I loved her and noticed for the first time subtle side to side eye movement. By 8:00 in the morning Daisy had an undeniable head tilt and her eyes were moving rapidly from side to side. I called the vet back to report the change in her symptoms and request a round of antibiotics. I am happy to report that after just 2 doses of antibiotics and 24 hours later my dog is lifting her head higher (still with a slight tilt) and is practically walking straight. Thank you so much for this post. It kept me from making what would have been a very devastating decision. Without all of your stories I never would have believed that a dog that looked rabid (drooling with crazy eyes and stumbling all over the place) could recover at all. My Daisy and I both thank you all from the bottom of our hearts for sharing your stories.

Submitted by Julie Turgeon | July 13 2014 |

My 12 yrs old mix lab Taiga is in her second day of the disease. Woke up yesterday morning at 5am and she had her head moving up and down, eyes right to left, could not stand up. I thought she was paralysed due to a stroke or eating poison outside and that I was on my way to put her down. It was terrible...

She stayed at the vet 36 hrs. They gave only anti vomitting meds only. They told me that if I am able to watch her and help her at home that I should bring her back home so she can ill in a peaceful environment with no stress of being with people she does not know.

My first night with her is so hard. I have tried to make her urinating by bringing her outside with the help of an support harness and a towel but she could not stand so it fails. It is been now 20 hours without urinating. Any other tricks? She eats well and drink enough I think. She also had 2 ACL replacement so her back legs are very weak.

I am also wondering if she can see me?

It is very painful to see her like this... Hope she does not have an infection and she will recover...

Those postings are very helpful thank you.

Julie

Submitted by Julie | July 16 2014 |

Taiga is now at day 5. She Can now walk very short distance but very unbalanced and stand up by herself on adhesive surfaces like grass or woodchips. I still need to carry her outside. She has sleeping problem and needs to go out at night at least one time. She has her head almost 90 degree left but her eyes seem more normal now. I give her massage on her legs and neck. Hope she will get better. It is a very rough time.

Submitted by Julie | July 19 2014 |

Day 7 : she is now in a very good mood. She sleeps better and she can stand up and walk! But she looks totally drunk, which is now make us smile as we see progress. Now we only hope she will get back to her normal balance so she can chase squirrels as before....

Submitted by Natasha | July 16 2014 |

I am so happy to have found this page and to hear other dog owners sharing their stories. Yesterday when we woke up our 13 year old samoyed couldn't walk, had a 45 degree head tilt and horizontal shaking eyes, took her to the vet in the morning hoping she would get better but got a phone call at 4pm saying there was no choice but to put her to sleep. We asked if there was any chance of having her home for the night or having her stay at the vet over night to see if she improves as it happened so suddenly but was told no. We were all saying our last goodbyes to our best friend when a different vet came into the room and told us to take her home as she has seen dogs make a full recovery from this. It wasn't until we got her home that I started researching this and found this page. She has been having some trouble with ear infections in the past so we're hoping that's what has happened rather than a brain tumour.

Today she still can't walk however her eyes have improved drastically, still some slight horizontal movement. She is eating and drinking and is responding well to us talking to her (e.g. when asked for a kiss she would always give us a little lick, she wasn't doing it yesterday but is doing it today.) she is on antibiotics and steroids. She has not vomited, however the vet gave her a motion sickness injection yesterday so she may need motion sickness treatment once that wears off.

I have been reading that within the first 72 hours is the best time to tell whether or not she will recover, however I have read that it can take up to two weeks for the dog to start walking again. My Dad is worried that if after a week she isn't walking then we may have to put her to sleep, I really hope that doesn't happen.

Thank you everyone for giving me hope, saying my last goodbye to her yesterday was heartbreaking and I do not want to do it again any time soon.

Natasha

Submitted by Julie | July 19 2014 |

Hi Natasha,

Taiga, my 12 yrs old mix-lab, is at her 7th day today. It took her 4 days to be able to stand up and walk by herself. She now can walk but look like she is drunk!

Be patient, it worth it! This website help me a lot...

Stay strong!

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