What is vestibular syndrome in dogs?
Vestibular syndrome is a disorder of the system that controls balance. The vestibular system has a peripheral part, in the inner ear and the vestibular nerve, and a central part, in the brainstem and cerebellum. When either of them is affected, the brain receives the wrong information about the position of the head, and the dog feels as if the world is spinning.
The condition is not rare: a study of dogs seen in ordinary first-opinion veterinary practices in the UK found about 8 cases per 10,000 dogs, with a median age at diagnosis of almost 13 years.
What are the signs of vestibular syndrome?
The signs usually appear suddenly, sometimes overnight:
- a head tilt to one side, the most common sign;
- nystagmus: the eyes move rhythmically, usually from side to side;
- positional strabismus: one eye drops when the head is lifted;
- a wobbly gait, with falling, rolling or circling towards the same side;
- nausea: drooling, vomiting, refusing food; a dog can feel sick without actually vomiting.
With peripheral vestibular syndrome there may also be facial nerve paralysis (a drooping eyelid or lip on one side) or Horner's syndrome (a small pupil, a drooping eyelid and a visible third eyelid), especially when the cause lies in the ear.
Is the vestibular syndrome peripheral or central?
The difference matters most for the prognosis: the peripheral form is usually milder, while the central form points to a disease of the brain. The neurological examination tells them apart through a few signs:
| Peripheral (ear, nerve) | Central (brain) | |
|---|---|---|
| Level of consciousness | Normal, although the dog seems dizzy and frightened | May be altered: drowsy, dull, disorientated |
| Foot placement | Normal when tested | Deficits: the dog is slow to correct the position of its paws |
| Nystagmus | Horizontal or rotatory | May be vertical or different in the two eyes |
| Other cranial nerves | Only the facial nerve may be affected | Other nerves may be affected too: swallowing, the jaw muscles, sensation in the face |
| Course | Improves over days | Stays the same or gets worse |
Central vestibular syndrome can be caused by inflammation of the brain, tumours or strokes. Diagnosing it usually needs an MRI scan and sometimes analysis of the cerebrospinal fluid (CSF).
What is idiopathic vestibular syndrome in older dogs?
It is the most common form of peripheral vestibular syndrome, often called “old dog vestibular disease”. “Idiopathic” means that no cause is found. It occurs mainly in dogs over 9 years old, comes on suddenly, is not painful and starts to improve on its own. In a study of 188 dogs with peripheral vestibular syndrome, 68% had the idiopathic form and 26% had a middle or inner ear infection (otitis media or interna).
The diagnosis is made by ruling other things out: the vet examines the ears, carries out a neurological examination, and recommends blood tests (including thyroid hormones) and a blood pressure measurement. If the signs are not typical, imaging comes next.
How long does vestibular syndrome last in dogs?
Most dogs with the idiopathic form show some improvement within a few days, and the signs usually disappear completely within 2-4 weeks. The head tilt is usually the last sign to correct itself.
Not every dog recovers fully. In a study with one year of follow-up, 27% of dogs with the idiopathic form were left with a slight head tilt, and 22% had another vestibular episode. Dogs left with a slight head tilt usually live normally.
Which ear problems cause vestibular syndrome?
The most important is otitis media or interna, that is, infection or inflammation of the ear behind the eardrum. Clues: discharge or a smell from the ear, scratching, head shaking, pain when the ear is touched, and sometimes facial paralysis or Horner's syndrome on the same side. Otitis media needs targeted treatment, different from the care given for the idiopathic form, and the diagnosis requires an examination of the ear and sometimes imaging. Less common peripheral causes are injuries, tumours and inflammation of the nerve.
When is vestibular syndrome worrying?
Signs that suggest a central cause or another serious disease:
- your dog is drowsy, confused or hard to wake;
- it drags its legs or does not place them correctly;
- the nystagmus is vertical or changes direction;
- it has difficulty swallowing or other signs affecting the face;
- the signs do not improve at all in the first few days, or they get worse;
- seizures or episodes that come and go appear.
Go straight to the nearest emergency vet clinic that is open now if your dog has seizures, if it can no longer be woken or cannot get up at all, if it vomits repeatedly and cannot keep water down, or if you have noticed other serious signs, for example difficulty breathing.
A neurological consultation tells you where the problem comes from and what to do next.
How is vestibular syndrome treated in dogs?
Treatment depends on the cause. There is no treatment that makes the idiopathic form heal faster: the vet treats the nausea and dehydration, and time does the rest. For several medicines suggested to shorten the illness there is so far no solid evidence, and in the 2023 study most of the neurologists surveyed relied mainly on a drip and an anti-sickness medicine. Otitis media or interna needs targeted treatment, and the central forms are treated according to the disease found on MRI and CSF analysis. That is why it matters to know which form your dog has before treatment starts.
What can you do at home for a dog with vestibular syndrome?
Supportive care is, in fact, the main treatment for the idiopathic form:
- A safe space: a soft bed on the floor in a quiet room, with no stairs or furniture to fall from.
- Food and water within reach: raise the bowls to head height and help your dog eat by holding it steady. Small, tasty pieces are more readily accepted.
- Assisted trips outside: take your dog out often, in a harness, supporting it with a towel under the belly.
- Anti-sickness medicines are chosen by the vet; in severe cases a dog may need a drip to stay hydrated until it eats and drinks on its own.
- Gradual exercise: once your dog can stand, short walks help it readjust.
Call your vet if your dog has not drunk any water for a day, if it vomits repeatedly or if it is not passing urine.
When should you come for a neurological consultation?
A neurological consultation is useful when the signs do not fit the idiopathic form, when improvement is slow, when episodes keep coming back or when the dog is young. The examination shows whether the lesion is peripheral or central and which investigations make sense. Short episodes of imbalance that come and go can be confused with seizures or fainting; the differences are explained in the article seizure or fainting. For other signs, see the guide to neurological symptoms in dogs. If you are coming from another town, read the information for patients from outside Cluj.
A neurological consultation tells you where the problem comes from and what to do next.
Frequently asked questions
Is vestibular syndrome in dogs a stroke?
Usually not. The most common form in older dogs is the idiopathic one, which starts in the inner ear and the vestibular nerve. Strokes can cause similar signs, and the neurological examination helps tell them apart.
Is a dog with vestibular syndrome in pain?
The idiopathic form is not painful. The dog is, however, dizzy and frightened, may feel sick and may refuse food. Pain when the ear or head is touched points to another cause, for example an ear infection.
Can vestibular syndrome come back?
Yes, in some dogs. In one study, about one in five dogs with the idiopathic form had another vestibular episode within the first year. A new episode is worth having re-examined, because another cause needs to be ruled out.
Can I take my dog with vestibular syndrome for a walk?
Only briefly, on flat ground, in a harness and on a short lead, once your dog can stand up unaided. Walking helps the brain adapt, but falls on stairs or slippery floors must be avoided.
Sources
- Mertens AM, Schenk HC, Volk HA 2023, Current definition, diagnosis, and treatment of canine and feline idiopathic vestibular syndrome, Frontiers in Veterinary Science
- Orlandi R. et al. 2020, Clinical signs, MRI findings and outcome in dogs with peripheral vestibular disease: a retrospective study, BMC Veterinary Research
- Radulescu SM et al. 2020, Vestibular disease in dogs under UK primary veterinary care: epidemiology and clinical management, Journal of Veterinary Internal Medicine
- MSD Veterinary Manual (Dog Owners), The Neurologic Evaluation of Dogs
This article is for information only and does not replace a veterinary consultation.