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. Sometimes these sorts of symptoms are assumed to be a brain tumor and the dog is euthanized-maybe unnecessarily. A much more common and less concerning cause of these and other disturbing signs, is something known as idiopathic vestibular disease.

Idiopathic (meaning unknown cause) vestibular disease is a syndrome that looks really bad, but usually gets better all on its own with little or no treatment. 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:
  • A head tilt,
  • An unsteady gait, loss of balance, or falling over,
  • Circling in one direction,
  • Eyes rapidly moving from side to side, known as nystagmus,
  • Sudden vomiting.
Unfortunately these clinical signs are not unique, or diagnostic for, idiopathic vestibular disease and other things can cause this same presentation. These can include a brain tumor, an inner ear infection, inflammatory disease or sudden bleeds into the brain-to name a few. However, when the symptoms seemingly appear out of nowhere in an older dog, there is a good chance of improvement.

If a visit to the vet doesn't reveal any obvious signs for a disease and 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. 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).

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).

Idiopathic vestibular disease is the most common form of vestibular disease in dogs. It is not a painful condition and there is a high likelihood that improvement will be seen. 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.

Shea Cox, DVM