Head Tilt and Balance Problems in Dogs and Cats

Balance problems in dogs are a relatively common neurological condition. Head tilt, incoordination and abnormal eye movements are common clinical signs. Owners may state that their dog has vertigo, is off balance or had a stroke.

Anatomy of the Vestibular System and Clinical Signs

The vestibular system can be thought of as the peripheral vestibular system and the central vestibular system. The peripheral vestibular system is made up of the parts of the vestibular system that are outside of the brain (receptor in the inner ear and the nerve). The central vestibular system is the part of the balance system inside the brain (vestibular nuclei and their connections to other parts of the brain and spinal cord).

Clinical signs of dysfunction of the vestibular system include head tilt (the head is cocked to one side so that one ear is closer to the ground than the other), vestibular-quality ataxia (leaning/falling/rolling to the side), and abnormal eye movements or position (nystagmus or strabismus, respectively). A thorough neurological examination is used to determine if the problem is affecting the peripheral or central vestibular system. This is important to determine since the diseases, treatments and prognosis are very different.

Causes of Vestibular Disease

Causes of peripheral vestibular disease include ear infections, idiopathic geriatric vestibular disease, toxins, hypothyroidism, cancer and others.

Causes of central vestibular disease include encephalitis, brain tumors, strokes and others.

Diagnostic Approach

A thorough history and general physical examination are performed. A neurological examination may determine if the problem is localized to the peripheral or central vestibular system. Blood tests, blood pressure measurement, X-rays, magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) analysis are useful in determining the cause (and potential treatments) of vestibular disease. Computed tomography (CT) scans typically are not sensitive enough to evaluate the central vestibular system.

Treatment and Prognosis

Treatment and prognosis can vary widely and depend on coming to an accurate diagnosis. Many causes of vestibular disease carry an excellent prognosis and/or can be managed with medications.