Disorientation in Dogs

Disorientation can occur acutely, or develop and worsen over time depending on the cause. You may notice that at times, or consistently, your dog is developing what seems to be a struggle to maintain a balanced position, or perhaps all of a sudden his eyes cannot focus and dart back and forth. Disorders related to the vestibular system can be broken down into peripheral and central disease. It is a common neurological condition in dogs, with no predisposition to sex or breed.

Disorientation, head tilt, and loss of balance are all common to an upset in the vestibular system. This system is responsible for maintaining and stabilizing the position of the head (which thereby gives the body stability), and the eyes during head movements. Vestibular disease will interfere with your dog’s entire sense of balance. It is important to take your dog to the veterinarian in order to correctly diagnose the cause and rule out other conditions such as an ear infection, stroke or hypothyroidism.

There are many symptoms associated with vestibular disease. Prompt attention by a qualified primary veterinary caregiver is the best course of action and will result in the most positive prognosis. Schedule a visit for your dog with the appropriate veterinarian without delay if you see any of the following abnormal signs:

• Head tilt (this can range from mild to severe)
• Darting eyes (nystagmus)
• Eyes which are abnormally aligned and may be accompanied by a squint (strabismus)
• Drooping eyelid or presence of third eyelid (Horner’s syndrome)
• Facial paralysis
• Head tremor
• Circling
• Falling or rolling to one side
• Unsteady gait (ataxia) or inability to walk
• Unable to stand, or uses a wide stance
• Vomiting or Nausea
• Development of motion sickness when in a vehicle

Types

Vestibular disorders are either peripheral or central. The vestibular system is an important and critical part of the central nervous system, coordinating an animal's vision (focus) and gravity (detected by skin receptors which pick up on external pressures). The sense of orientation experienced by your pet will be affected by the proper function of these neural systems.

Two of the more common causes of Peripheral Vestibular disease are:

• Idiopathic vestibular disease - This is a peripheral disorder. It presents with acute onset and severe nystagmus (rapid, darting eyes), which causes extreme vertigo because the eyes cannot focus on the horizon. The episode lasts between a few days to a few weeks, and usually the dog can be nursed through the condition with favorable recovery (occasionally a dog will end up with a permanent mild head tilt).. Some owners have been known to confuse idiopathic vestibular disease episodes as seizures. This condition tends to occur in senior dogs and can be called 'The Drunken Sailor Disease' due to the way they walk. Importantly, symptoms should not progress.
• Inner ear disease - Peripheral as well, inner ear disease has a slower progression and those affected may exhibit varying degrees of facial paralysis and Horner’s disease (drooping eyelid). The most common cause is otitis media (inflammation of the inner ear), with bacteria moving into the eustachian tube of the ear. Antibiotics can work well as a cure but may need to be given at high doses and for prolonged periods.

• Central vestibular disease - The prognosis is less optimistic for this type of disorientation in dogs. There can be brainstem damage, leading to cranial, motor, position and movement difficulties. Illnesses such as Lyme disease and liver dysfunction can precipitate central vestibular disease.

The causes for disorientation in dogs are not always completely understood; further studies will hopefully enlighten the medical field as to some of the mysteries of this condition.

Peripheral vestibular disease

When the ear and/or local nerve are affected, this is referred to as 'peripheral vestibular disease'. Potential causes include:

• Idiopathic Vestibular Disease
• Nasopharyngeal Polyps (more common in cats)
• Neoplasia (growth of abnormal tissues) within the vestibular system
• Conditions that cause a defect in chemical reactions in the body such as hypothyroidism (which can also cause central vestibular disease)
• Ototoxicity due to antibiotics
• Bacteria from otitis media

Central vestibular disease

• Head trauma
• Stroke
• Antibiotic toxicity
• Neoplasia
• Thiamine deficiency
• Granulomatous meningoencephalitis
• Liver disease (with metabolic brainstem degeneration)
• Lyme disease
• Canine distemper
• Rocky Mountain Spotted Fever
• Ehrlichiosis, which is a tick-borne bacterial infection

Vestibular syndrome / Idiopathic Vestibular Disease

• Thought to be a complication of old age, but can be seen in middle-aged dogs
• Studies show it may be related to inflammation of nerves connecting the inner ear to the cerebellum that controls equilibrium, spatial orientation and body balance

Prompt veterinary care is essential in order to diagnose the cause of the disorientation that your pet is experiencing. Having no balance, or having the sense of being unable to focus and walk will affect your dog in many ways. The veterinarian will concentrate on making your dog comfortable first and foremost. If the nausea and spatial disorientation are extreme, your veterinary caregiver will administer medication to ease the symptoms. Some pets, who have been too distressed and imbalanced to drink, for example, will be given intravenous fluids to hydrate them and improve their circulation.

The veterinarian will ask for a history of your pet’s behavior over the past weeks, and will want to know if you can pinpoint how and when the symptoms began. The assessment of the nystagmus (eye movement direction, horizontal or vertical for example) can help lead to a diagnosis. 

Ataxia (unsteady gait) may be difficult to interpret because of the stress that your dog is going through as a result of the imbalance issues, and the possible need of support for your dog to be able to walk. A non-slippery surface may be required because your pet will find any flaw in the surface difficult to navigate in his state.

Indications for the veterinarian may be facial paralysis (as in peripheral) or a change in mental activity or weakness on the entirety of one side (as in central). If your veterinary professional is unable to determine the diagnosis of why your pet is disoriented, she may choose further diagnostic tools.

After a complete physical and neurological examination, the veterinarian may decide to analyze baseline diagnostics by checking blood pressure, complete blood count, urinalysis, thyroid level and serum biochemical profile. Examination of the ear canal, or very careful removal of substances of the ear canal (for analysis) may be done.

If the veterinarian has a suspicion of a central lesion, or after a few days or weeks the symptoms are not ceasing, more intensive testing may be ordered. MRI (to image the brain or middle and inner ear) could be ordered to look for central or peripheral disease. If further testing is necessary, a further diagnostic option is a spinal tap to rule out meningitis or encephalitis.

It should be noted that some types of disorientation in dogs can clear up on their own while others may point to a more serious condition. A central vestibular disorder generally carries a poorer prognosis for successful treatment because the brainstem area does not respond well to neurosurgery. There are drugs currently under study with the hopes of offering a solution to the disease, as in the case of tumors for example.

In the case of peripheral disorders, the scenario is quite different. Please note the following treatment procedures that may accompany a diagnosis of a peripheral disorientation (idiopathic, inner ear or vestibular syndrome):

• All treatments will be based on the underlying cause
• Medication for nausea, vertigo and dizziness may be necessary
• Intravenous therapy can be utilized if your dog needs fluid recovery because he has not been eating or drinking enough
• Sedatives are sometimes used to calm dogs as a part of the recovery process
• Idiopathic vestibular disease tends to resolve with time and the support of the owner
• The inner ear responds well to antibiotic treatment but the duration of medication must be carefully monitored in order to fully treat the infection
• Surgery and radiation can be an approach to resolve abnormal tissue growth
• Complications due to antibiotic toxicity may be eradicated after the antibiotic is stopped

As is the case with any time that your pet is ill, follow up with the veterinarian is always part of the equation. The recovery process may be a challenge, but with your care and practical support, your dog can often resume a sense of normalcy. Your primary veterinary caregiver will remind you that patience as you await results is key with a diagnosis of any vestibular complication.

Remain calm and caring at all times. Offer comfort, warmth, and attention. Aid your dog as necessary with his balance needs as he navigates his new 'wobbly' life. Dietary changes might be suggested, as will a follow-up visit at the clinic a few days after the initial appointment. It should be noted that a head tilt may remain, even after your pet recovers. Relapse of vestibular disease may occur, depending on the underlying cause.

Disorientation can be symptomatic of something more serious. To avoid high vet care expenses, secure pet health insurance today. The sooner you insure your pet, the more protection you’ll have from unexpected vet costs.