Vestibular Disease

Question 1

What other signs may be seen in peripheral vestibular disease? I.e other structures in the middle ear

Answer 1

Facial nerve paralysis

Horners syndrome

Question 2

What are the most common differentials for central vestibular disease?

Answer 2

Cerebrovascular accident
Meningioencephalomyelitis of unknown origin
Metronidazole toxicity

Question 3

What are the most common differentials for peripheral vestibular disease?

Answer 3

Otitis media / interna

Idiopathic vestibular disease

Question 4

What are the most common causes of acute onset vestibular disease?

Answer 4

Idiopathic vestibular disease
Cerebrovascular accidents
Metronidazole toxicity

Question 5

What are the most common causes of chronic vestibular disease?

Answer 5

Otitis media/interna
MUO
Brain and middle ear tumours

Question 6

Describe how cerebral vascular accidents present and how they should be managed.

Answer 6

Acute, non-progressive central vestibular disease
Most commonly due to ischaemi injury

Dx: MRI, normal CSF
Look for underlying disease - CKD, Cushings and hypertension

Management: resolves in 3-4 days

Question 7

What are the 3 disease types seen in meningioencephalomyelitis of unknown origin?

Answer 7

Granulomatous meningoencephalomyelitis
Necrotising meningoencephalomyelitis
Necrotising leucoencephalitis

Question 8

What is the typical distribution and progression of MUOs?

Answer 8

Acute, multifocal, progressive

Question 9

How should you work up an MUO?

Answer 9

MRI
CSF analysis
Biopsy under guidance
Serology / PCR

Question 10

What is the typical presentation of GME?

Answer 10

Young adult, toy and terrier breeds

1. Disseminated - multifocal - brain, SC, cerebellum, brainstem
2. Focal - ddx neoplasia
3. Ocular - sudden onset blindness and no PLR

Dx: MRI - hyperintensitises in the WM
Nuetrophilic, lymphocytic of mixed pleocytosis on CSF and increased proteins

Better px than NLE

Question 11

What is the presentation of necrotising leucoencephalitis?

Answer 11

1. Necrotising meningoencephalomyelitis 
Pug, Maltese, chihuahua - middle aged 
Acute onset, rapidly progressive, worse prognosis - 3m survival
Grey and white matter 
Control AEDs

2. Necrotising leucoencephalitis
   Young to middle aged Yorkies and French Bulldogs
   Peri-ventricular white matter

Non-suppurative meningoencephalomyelitis and cerebral necrosis

Question 12

How can you treat MUOs?

Answer 12

Immunosuppression
Corticosteroids
Cytosine arabinoside

Question 13

How does FIP present neurologically?

Answer 13

Immune complex mediated vasculitis
Young cats, progressive

Commonly at the cerebromedullary region
- tetraparesis, ataxia, nystagmus and loss of balance

Question 14

How can you diagnose FIP?

Answer 14

FCoV PCR from CSF sample

MRI findings - hydrocephalus, peri-ventricular contrast enhancement, ventricular dilation

Question 15

How does vestibular disease due to otitis media / interna present?

Answer 15

Vestibular signs
Horners
Facial paralysis
Pain opening mouth

Very often secondary to atopic dermatitis

Question 16

How does metronidazole toxicity present? And how can it be resolved?

Answer 16

Rigidity, hypermetria, hunched back
Doses exceeding 60 mg/kg/day

Tx: discontinue drug, diazepam

Question 17

Name some ototoxic drugs.

Answer 17

Aminoglycosides- streptomycin, gentamycin
Chlorhexidine
Chemo agents - cisplatin, vincristine, vinblastine

Question 18

What is different about vestibular disease caused by thiamine deficiency?

Answer 18

Bilateral vestibular disease
Crow low to the ground
Head turn and circling in either direction

Question 19

What are the clinical signs of bilateral vestibular disease?

Answer 19

No head tilt
No pathological nystagmus
No vestibular ocular reflex 
Crouch low to the ground 
Fall to either side

Question 20

What is the presentation of idiopathic vestibular disease and what is the prognosis?

Answer 20

Acute onset peripheral vestibular disease
Unilateral
Older dogs

Spontaneously recover - usually within 2-4 weeks
May be left with a residual head tilt

Question 21

What is the clinical presentation of feline vestibular disease and what is the prognosis?

Answer 21

1. Acute form - acute onset peripheral vestibular disease that improves in 2-4 weeks
2. Atypical form - clinical signs progressive over 3 weeks
   Recovery occurs over 3 months

Question 22

What is the presentation of idiopathic facial and vestibular neuropathy and what must you make sure the owner does?

Answer 22

Spaniels and boxers

Acute onset facial paralysis / paresis
Vestibular disease

Ensure the owner lubricates the eye as they can’t blink
Usually recover in several weeks

Question 23

How should you investigate concurrent disease in vestibular diseases?

Answer 23

Haematology
Biochemistry
Thyroid panel

Question 24

How should you investigate peripheral vestibular disease?

Answer 24

Examination of the ear canal and TM
Swab for culture and sensitivity if TM broken
Myringotomy if indicated 
Lavage 
Radiographs, CT or MRI

Question 25

How can you investigate central vestibular disease?

Answer 25

MRI
CSF analysis
Blood pressure
Urine analysis
Abdominal US 
Thoracic radiographs
Serology

Question 26

What is the most sensitive indicator of a central vestibular problem (cerebellum)?

Answer 26

Ipsilateral (on the same side) proprioceptive deficits