Vestibular disease affects the balance system. Like vertigo in people, pets with vestibular disease may feel dizzy or off-balance. They often have a head tilt and abnormal eye movement (nystagmus), and they may circle, roll, or have difficulty standing and walking. Some pets vomit when they first develop these signs, and many become very anxious.
The vestibular system is comprised of structures within the inner ear and specific parts of the brain. When pets are evaluated for acute onset vestibular signs, we try to localize the disease to the brain or to the peripheral nerves (including the inner ear). Vestibular signs can be dramatic in both cases and these pets can be challenging to evaluate when they are unable to stand and/or are rolling vigorously. However, if other neurologic deficits are observed during an exam, or the pet family has noticed behavior changes at home, this may suggest a problem in the brain rather than the peripheral nervous system.
Inflammation, infection, tumors or polyps, strokes, toxins, or trauma to any part of the vestibular system can cause vestibular signs. In many cases, there is no underlying cause identified which is known Idiopathic vestibular disease. Idiopathic vestibular disease often gets better without specific treatment, but improvement can take days to weeks and pets may require supportive care during that time. They often require assistance walking outside to use the bathroom and may need food and water brought to them. Importantly, idiopathic vestibular syndrome is localized to the peripheral nervous system, not the brain.
If a brain lesion is suspected, other causes including strokes, cancerous processes, toxins, infections, and inflammatory diseases are possible and a veterinary neurology consultation should be strongly considered. Some of these disease processes will get better, while others will progress without targeted treatments. Vestibular signs from transient ischemic attacks (like a short-lived stroke) or certain toxins may improve within hours. Pets with more substantial but non-catastrophic strokes may take days to weeks to improve. It is worth noting that in cats, strokes may be due to significant underlying heart disease, which should be further evaluated on an emergency basis to rule-out concurrent heart failure. Pets with cancerous processes, infections, or inflammatory diseases may worsen without specific treatments.
Diagnostics for a pet with vestibular signs may include a blood pressure, blood work, and urine testing to evaluate for risk factors for strokes and other disease processes. Chest radiographs (x-rays) may also be advised to look for any evidence of cancer and to ensure the heart appears to be normal in size.
Physical rehabilitation may help to hasten recovery in pets that have vestibular disease.