Head Tilt in Cats

Key Takeaways

Head tilt refers to an abnormal posture of the head, where the head is tilted to one side with one ear lower than the other. 

• Diagnosis of the underlying cause is made through physical examination, blood work, ear cytology, advanced imaging (CT, MRI), biopsy, nutritional status evaluation, and even possibly CSF analysis (spinal tap)

• The most common causes of head tilt in cats are vestibular syndrome and ear infections

• More serious causes include cancer and traumatic injury

• Treatment depends on underlying cause and may include antibiotics, antinauseant medications, nutritional supplementation, fluid replacement therapy, chemotherapy, and surgery

• The precise treatment strategy and prognosis depend on the underlying condition

A Closer Look: What is Head Tilt in Cats?

Head tilt in cats is usually a sign of dysfunction of the vestibular system, which regulates balance. When this system is disrupted, cats feel unbalanced and often develop a head tilt in an attempt to maintain balance.

Possible Causes

Causes of head tilt include:

• Infections, particularly of the middle or inner ear • Cancer • Toxins • Traumatic injury

• Metabolic disease • Nutritional deficiency, particularly thiamine deficiency • Vascular accident (“stroke”)

• Dysfunction of the vestibular system from an unknown cause

Risk Factors

Head tilting is uncommon in cats. The degree of head tilt may vary, but this does not correlate with the severity of the underlying cause. Any time a cat is head-tilting, prompt veterinary attention is advised. Head tilt in cats has several potential causes. Some of these causes can be serious and life-threatening, such as brain trauma or cancer. Cats showing symptoms such as difficulty moving, confusion, severe lethargy, or incoordination require emergency veterinary care.

Testing and Diagnosis

A veterinarian presented with a cat with head tilt begins with a thorough physical examination. Other diagnostic tests include:

• Blood work • Ear swab • Diagnostic imaging, including X-rays, CT, or MRI • Evaluation of nutritional status

• CSF analysis (spinal tap) • Biopsy

Treatment depends on the underlying cause. Examples are:

• Medication (anti-nauseants, antibiotics) • Fluid replacement therapy • Surgery • Chemotherapy

• Nutritional supplementation

Sometimes head tilt is permanent despite treatment.

Similar symptoms

Head tilting may appear similar to another neurologic symptom called head turning. In head turning, the head is turned to one side, rather than having the head straight in line with the body. Often this symptom is accompanied by constant circling in the direction of the head turn.ac

Associated Symptoms

Ataxia (staggering/falling over) • Nystagmus (rapid side-to-side eye movement)

Vomiting • Abnormalities of the eyes and face (drooping, raising of third eyelid, sunken eye, apparent squinting)

• Turning in circles

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