Vestibular disease in cats is a syndrome in which the balance system of the brain and middle ear is disrupted, causing incoordination.
• Symptoms include uncoordinated gait (ataxia), rapid eye movements (nystagmus), loss of balance, and head tilt
• There are many potential underlying causes however it is most common that the cause cannot be determined (idiopathic)
• Other causes include middle- or inner-ear infections, tumors, and toxicoses
• Diagnosis is often by exclusion; a full workup is required to rule out potential causes and includes physical and neurological examination, bloodwork, urinalysis, and advanced imaging (CT, MRI)
• Treatment depends on the underlying cause
• Idiopathic cases are treated symptomatically
• Prognosis is good, with most cats showing improvement within days and resolution within weeks
• Some symptoms may be permanent, such as head tilt
The vestibular system acts within the body to determine a sense of balance and bodily positioning. One component of the system is the inner ear which functions to deliver information about head and body positioning to the brain to orient the individual. Malfunctions of the vestibular system can lead to incoordination, ataxia, and other neurologic-appearing symptoms.
Vestibular signs are commonly referred to as “stroke,” which is possible as an underlying cause, but strokes are rare in cats.
Vestibular disease itself is not an emergency, but sudden and severe onset of symptoms can be alarming. Because some underlying causes are potentially life-threatening, emergency veterinary care is warranted. Safety changes to cats’ environments are necessary to prevent them from injuring themselves in their uncoordinated state (preventing access to high places, low-entry litter boxes).
Symptoms may be acute (sudden) or chronic (slowly worsening) in onset, and may include nausea, vomiting, and facial paralysis (manifesting as facial drooping).
While most cases are idiopathic (unknown cause), there may be a genetic component as it is seen more often in purebred Siamese and Burmese cats.
Vestibular disease results when there is a disruption in the balance system located in the brain and middle ear. Common causes of vestibular disease include:
• Idiopathic (cause cannot be determined; most common)
• Middle- and inner-ear infections (also common in cats)
• Inflammatory disease, such as FIP
• Infarction (blood clots)
• Drug toxicosis
• Genetic (hereditary in purebred Siamese and Burmese cats)
• Loss of balance
• Nystagmus (rapid, side-to-side eye movements)
• Falling over
The first step of diagnosis of a possible case of vestibular disease is a full physical and neurologic exam and gathering of detailed medical history. In some cases, diagnostic imaging (CT or MRI) may be recommended to better visualize the structures of the ear and brain. Workup also typically includes blood work and urinalysis. Diagnosis is often by exclusion of other potential disease processes.
Treatment addresses the underlying cause if one can be identified, for example, antibiotics for ear infections or surgery for tumors. If idiopathic, treatment is supportive and targets symptoms. For example, IV fluids can be used to correct dehydration or anti-nausea medication.
In cases where the underlying cause cannot be treated, such as with certain cancers or FIP, euthanasia may be considered.
Duration of disease varies depending on the underlying cause. Prognosis for vestibular disease is good in most cases. Generally, improvement is seen in 2-3 days, and resolution in a few weeks, though some symptoms (such as head tilt and facial paralysis) may be permanent. If symptoms do not improve, further investigation is needed.
Prevention is highly dependent on the underlying cause of the vestibular disease. Idiopathic vestibular disease cannot be prevented as the cause is not known or cannot be determined. In other cases, preventing potential underlying causes, such as ear infections, is the only recommendation. Regular veterinary visits can help prevent conditions that may lead to vestibular symptoms.
Vestibular disease is not very common in cats.
Supportive care while waiting for improvement:
• Assistance with urination and defecation
• Assistance with eating and drinking
• Anti-nausea medications
• Physical support to prevent injuries due to falls
• Anti-anxiety medications
Targeted treatment dependent on the underlying cause:
• Surgery for tumors or polyps
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