Idiopathic or “Old Dog” Vestibular Disease

Vestibular signs in dogs are often incorrectly referred to as a stroke
By Shea Cox DVM, April 2012, Updated September 2020
Dogs with idiopathic vestibular disease, "Old Dog Syndrome", Misunderstood ailment

A fairly common reason for a veterinary visit is the concern that an older dog has had a stroke or a seizure, when the dog 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.

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

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

According to Beverly Sturges, DVM, associate professor of clinical neurology/neurosurgery at the UC Davis School of Veterinary Medicine, the most frequent cases are referred to as idiopathic or “old dog” vestibular disease because it’s most often seen in older dogs and there’s no obvious cause. “It’s benign; we still have no real understanding why it occurs,” she says. “It’s self-limiting, [requiring] no treatment except supportive care and comforting the dog,” she adds. Learn more about related disorders central and peripheral vestibular disease in dogs.

Vestibular Disease Symptoms

The vestibular system in dogs 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 typically have some combination of the following signs:

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  • A head tilt
  • An unsteady gait, loss of balance, or falling over (ataxia)
  • Circling in one direction
  • Eyes rapidly moving from side to side (nystagmus)
  • Sudden vomiting

The videos at the end of this post show a dog with nystagmus, a dog with mild, but very typical, vestibular signs and another dog with more severe signs of idiopathic vestibular diease.

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. Other illnesses that display these symptoms can include a brain tumor, an inner ear infection, inflammatory disease or sudden bleeds into the brain—to name a few. The sudden onset of vestibular disease can also look like a seizure; the two are can hard to distinguish. Actually seeing the episode would be helpful for diagnostic purposes, so it might be good to record and show to your vet.

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.

Diagnosis and Treatment

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 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 clinical signs are mild, pets can often be managed at home with over-the-counter meclizine (for the feelings of “motion sickness” they experience). 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. 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 the dog has 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 dogs within this 72 hour time frame. The dog should recover and return to normal in 7 to 14 days (although in some dogs, a head tilt will still persist).

It should also be noted that idiopathic vestibular disease in dogs 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.

Shea Cox earned a veterinary medical degree from Michigan State University in 2001 and has been practicing emergency and critical care medicine since. In 2006, she joined PETS Referral Center. In her spare time, she loves to paint, wield her green thumb and cook up a storm. She shares her days with the three loves of her life: her husband Scott and their two Doberman.