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My dog had an episode (last Wednesday) of rapid eye movement…

Hi, my dog had an...
Hi, my dog had an episode (last Wednesday) of rapid eye movement followed by stumbling and then fell on one side, and not able to stand up. I could not lift him as he was struggling and kicking. Would like to seek advice.
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Customer reply replied 6 months ago
My dog is 12 years and 4 months old and on thyroid medication since 2013 (blood test for T4 one month ago was okay). About 10 to 15 minutes before the episode, he was exposed to some fumigation (outdoor fogging for moisquitoes) for a short while. He was able to walk (but not steady) after resting for about 30 minutes at the vet clinic. Blood test was okay.
Answered in 51 minutes by:
1/9/2018
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Pet
Satisfied Customers: 34,783
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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Your dog's nystagmus (eyes flicking back and forth) and ataxia ("drunken sailor") are pathognomonic (specifically indicative) of vestibular (balance) disorders. Because he normalized so quickly, an intoxication as you mentioned is the most likely cause of the disorder. Idiopathic (unknown cause) vestibular disorder (also called "old dog vestibular disorder") is most common at his age but doesn't normalize so quickly. Peripheral vestibular disorders involving the inner/middle ear should be a consideration - vertigo/vestibular neuritis - because episodes of vertigo can arise suddenly and disappear just a quickly. Central vestibular disorders involving the cerebellum and/or brain stem cause more serious central nervous system signs which may persist over days and months and never abate. Please respond with further questions or concerns if you wish.

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Customer reply replied 6 months ago
Thanks. To help me in understanding, the probable causes are intoxication or peripheral vestibular disorders? What could be further assessed to determine if it is related to peripheral vestibular disorders? The vet checked last Wednesday that there was no ear infection (but he had prior history of ear infection and occasionally he would tilt his head if one touched his head) and there was slight head tilt to the right at the vet last week. For idiopathic vestibular disorder, what symptoms would not normalize so quickly? Thanks.

Correct. The external ears are directly visualized with an otoscope as his vet did last Wednesday but to see into the inner/middle ear(s) imaging in the form of X-rays and CT are utilized. Head tilt, nystagmus, and vestibular quality ataxia are hallmarks of all vestibular disorders. Nystagmus tends to abate quickly; ataxia can persist and improve over a couple of weeks; head tilt may persist indefinitely. Please continue our conversation if you wish.

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Customer reply replied 6 months ago
If it is peripheral vestibular disorder, are there some triggers or preventive measures that we should take note? He is currently not walking too steadily (but as he was limping and also had problem lying down a few days before the episode), I'm not sure what is causing the unsteadiness gait. He is taking Previcox as needed for the limping and currently on Baytril for skin abscess since last Wed.

No, the cause (the trigger) of the peripheral disorder would need to be identified and treated effectively which would then hopefully prevent worsening or recrudescence (relapse without cure in between events). The unsteadiness indicates vestibular ataxia. Once again, the cause would need to be identified and treated effectively and in many cases that cause is idiopathic (unknown cause). The drugs aren't a likely cause of his signs but please note that rare instances of ataxia have been seen with enrofloxacin (Baytril).

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Customer reply replied 6 months ago
Hi Dr Salkin, regarding the assessment for possible peripheral disorder, what would be seen in the x-ray if it is linked to middle/inner ear? I'm keen to ask the local vet to do x-ray (but not so comfortable with CT as it involves GA). Regarding the other possible cause of intoxication from the fumigation, may I check if you had encountered signs of vestibular symptoms from intoxication in clinical practice? Thanks for your advice.

Thickening of the lining of the osseous bulla - the compartment of the middle ear. There may also be evidence of fluid in the compartment. Those X-rays need some sort of sedation as well. Yes, I've seen many pets demonstrating vestibular signs when intoxicated with prescription and recreational drugs as well as other chemicals. You're quite welcome.

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Customer reply replied 6 months ago
Many thanks for your prompt reply and for highlighting the x-rays require some sort of sedation. Is it advisable to perform this x-ray when the dog is still having the vestibular symptoms such as ataxia or when the dog is better or recovered?

The sooner the better. I might discover something that might allow early treatment and resolution of signs.

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Customer reply replied 6 months ago
Sorry, one last question so that I know what to look out for. Would the vestibular episode always involve nystagmus? The body weakness (leaning to one side and unsteady gait) first occurred in Oct last year but without nystagmus and he normalized within about 1 hour.

No, nystgmus need not be present.

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Pet
Satisfied Customers: 34,783
Experience: University of California at Davis graduate veterinarian with 45 years of experience
Verified
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Customer reply replied 6 months ago
Thank you very much. So the Oct episode might be the first instance of the vestibular symptyoms presentation. Appreciate your advice.

Thank you for your kind accept. I appreciate it. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

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Hi,

I'm just following up on our conversation about your pet. How is everything going?

Dr. Michael Salkin
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