Alison Laurie-Chalmers: Balance problem may be passing but get it checked
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Tom was a 12-year-old yellow Labrador, who still behaved like a young pup.
He was brought in as he had suddenly become extremely wobbly while out on his walk, and was falling over to one side. He was examined and a diagnosis of idiopathic vestibular disease was given.
The vestibular system is responsible for maintaining normal balance, posture and orientation.
It has two functional areas – central components within the brain and peripheral components within the inner and middle ear and the vestibulocochlear nerve.
The system located within the inner ear comprises a vestibule and three semi-circular canals which work with the vestibulocochlear nerve and brain to sense, maintain and regain balance.
Vestibular disease causes a sudden disturbance of this balance. The problem may originate in the inner ear, vestibulocochlear nerve or the brain. It is common in older dogs and is also referred to as “old dog vestibular syndrome” and “canine idiopathic vestibular syndrome”.
The clinical signs are a sudden onset of loss of balance; a wobbly gait; disorientation; circling or deviating towards the side of the problem; a reluctance to stand up; a wide-based stance; a head tilt; irregular, jerking eye movements and vomiting.
Causes include middle or inner ear infections; central brain disease; some drugs toxic to the inner ear; trauma or injury; tumours pressing on these structures; hypothyroidism; a cerebrovascular accident causing a brain infarct; or idiopathic vestibular syndrome, which means there is no obvious or known cause.
Diagnosis is based on a thorough medical history and the clinical signs and, if required, blood and urine tests, X-rays, and advanced tests and imaging.
Where no specific cause is found, these cases often have transient symptoms. Distinguished by the sudden onset of clinical signs and a subsequent noted steady improvement, thankfully often little or no intervention is required. Idiopathic vestibular syndrome is the most common form and extremely common in older dogs. Treatment options are supportive and, if possible, directed at the underlying cause. In severe cases intravenous fluids and hospitalisation may be required. If the dog is seriously disoriented and unable to stand or walk they may be given sedatives. Anti-nausea medications are beneficial. Antibiotics may be used, or anti-inflammatories.
The prognosis for recovery is very much dependent on the underlying cause.
The clinical signs are often most severe during the first 24 to 48 hours. Many pets then begin to improve within 72 hours. The head tilt and stumbling often improve over a seven to 10-day period, and patients recover within two to three weeks. Physiotherapy can be extremely useful since inactivity and recumbency results in decreased joint movement, stiffness and muscle weakness.
If the patient fails to improve or worsens, then a more severe disorder is then suspected, and referral for further advanced diagnostic testing and imaging is advised, and the patient’s quality of life may have to be discussed.
Thankfully old Tom recovered well from his transient vestibular episode.
Alison Laurie-Chalmers is a senior consultant with Crown Vets in Inverness.
