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DrLucy, Dog Veterinarian
Category: Dog
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Experience:  Almost 30 yr as a practicing small animal vet.; experience in gen.medicine, surgery, emerg/
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My dog has vestibulitis or a balance problem from undetermined

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My dog has "vestibulitis" or a balance problem from undetermined causes. The situation only happens when she shakes her head.... she clearly gets dizzy and sometimes falls over.   She had TPLO surgery back in early November but everything has been successful. She had full blown blood work done in October and again in early December and everything shows that she is very healthy. She had a urinalysis done as well. All looked good. She is eating fine, drinking fine, walking fine (outside of when she shakes her head and has the dizzy spells) and all in all looks fine. She is almost 13. Just recently though within the past couple of weeks, I have noticed some muscle atrophy on the left side of her skull. I thought it was from some weight loss due to her knee injury but its quite significant. Her jaw is fine so it does not appear to be masticatory myositis.   Nothing points to Cushings Disease. There is no sign of cancer but something is clearly wrong. Any suggestions?
Submitted: 7 years ago.
Category: Dog
Expert:  DrLucy replied 7 years ago.

This vestibular syndrome is very common in elderly dogs. Occasionally, it is caused by an inner ear infection, occasionally by hypothyroidism, and very rarely, by a brain tumor. The typical one we see so often in old dogs is considered "idiopathic," or of unknown cause. In most cases of these, the dog improves quickly--anywhere from one day to two weeks. Usually, the side-to-side eye movements improve first. The worst I have ever seen took about 2 weeks. Occasionally, dogs keep a mild residual head tilt or mild imbalance when shaking the head. A few dogs have more than one episode.


As far as what to do goes........Most important is to make sure that she can eat and drink successfully. You may need to carry her outside--go slowly, so she doesn't try to right herself. Raise her food and water dishes or, if needed, hand feed her and give her water by a turkey baster. It doesn't hurt to have a thyroid profile done, especially since you mentioned muscle atrophy. If she improves on her own, that pretty much rules out a brain tumor.


I hope this helps. Let me know if you have any more questions.



Customer: replied 7 years ago.
There is no side to side eye movement or any other sign of vestibular disease except for the balance issue when she shakes her head. she is eating fine and drinking fine with no issues and walking fine. The episodes happen several times a day...whenever she shakes her head. There is no head tilt at any other time.   I am assuming the thyroid profile is separate from a CBC or geriatric blood work up? We are going on two weeks now... she seems to shake her head more often. It started out as maybe once a day.. then two or three times a day and now it seems she shakes her head often during the day.   My vet did not feel any ear medication was appropriate since no sign of infection and thinks that it could be a bit of nerve damage causing the muscle atrophy. It just looks very severe and I am worried that it will start effecting the other side of her head as well. Her cheekbone is very prominent and her eye looks sunken in now.
Expert:  DrLucy replied 7 years ago.
Sometimes a geriatric blood profile will include thyroid tests, but you can't be sure without asking your vet. Your description does sound like something more than vestibular syndrome, or even an inner ear problem. I don't want to alarm you, but I think your next step (after a thyroid profile, of at least T4, freeT4 levels) would be to consult a neurologist. An EMG to check muscle electrical activity, and possibly a muscle biopsy, might be necessary. If the neurologist is concerned about a tumor, then a CAT scan could be done.
DrLucy, Dog Veterinarian
Category: Dog
Satisfied Customers: 618
Experience: Almost 30 yr as a practicing small animal vet.; experience in gen.medicine, surgery, emerg/
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Expert:  DrLucy replied 7 years ago.
In the mean time, you could try meclizine (Bonine) for her dizziness, if it seems to be getting worse. Bonine is available OTC and her dose would be 25 mg once a day.

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