Vestibular Disease Flashcards
What other signs may be seen in peripheral vestibular disease? I.e other structures in the middle ear
Facial nerve paralysis
Horners syndrome
What are the most common differentials for central vestibular disease?
Cerebrovascular accident
Meningioencephalomyelitis of unknown origin
Metronidazole toxicity
What are the most common differentials for peripheral vestibular disease?
Otitis media / interna
Idiopathic vestibular disease
What are the most common causes of acute onset vestibular disease?
Idiopathic vestibular disease
Cerebrovascular accidents
Metronidazole toxicity
What are the most common causes of chronic vestibular disease?
Otitis media/interna
MUO
Brain and middle ear tumours
Describe how cerebral vascular accidents present and how they should be managed.
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
What are the 3 disease types seen in meningioencephalomyelitis of unknown origin?
Granulomatous meningoencephalomyelitis
Necrotising meningoencephalomyelitis
Necrotising leucoencephalitis
What is the typical distribution and progression of MUOs?
Acute, multifocal, progressive
How should you work up an MUO?
MRI
CSF analysis
Biopsy under guidance
Serology / PCR
What is the typical presentation of GME?
Young adult, toy and terrier breeds
- Disseminated - multifocal - brain, SC, cerebellum, brainstem
- Focal - ddx neoplasia
- 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
What is the presentation of necrotising leucoencephalitis?
1. Necrotising meningoencephalomyelitis Pug, Maltese, chihuahua - middle aged Acute onset, rapidly progressive, worse prognosis - 3m survival Grey and white matter Control AEDs
- Necrotising leucoencephalitis
Young to middle aged Yorkies and French Bulldogs
Peri-ventricular white matter
Non-suppurative meningoencephalomyelitis and cerebral necrosis
How can you treat MUOs?
Immunosuppression
Corticosteroids
Cytosine arabinoside
How does FIP present neurologically?
Immune complex mediated vasculitis
Young cats, progressive
Commonly at the cerebromedullary region
- tetraparesis, ataxia, nystagmus and loss of balance
How can you diagnose FIP?
FCoV PCR from CSF sample
MRI findings - hydrocephalus, peri-ventricular contrast enhancement, ventricular dilation
How does vestibular disease due to otitis media / interna present?
Vestibular signs
Horners
Facial paralysis
Pain opening mouth
Very often secondary to atopic dermatitis
How does metronidazole toxicity present? And how can it be resolved?
Rigidity, hypermetria, hunched back
Doses exceeding 60 mg/kg/day
Tx: discontinue drug, diazepam
Name some ototoxic drugs.
Aminoglycosides- streptomycin, gentamycin
Chlorhexidine
Chemo agents - cisplatin, vincristine, vinblastine
What is different about vestibular disease caused by thiamine deficiency?
Bilateral vestibular disease
Crow low to the ground
Head turn and circling in either direction
What are the clinical signs of bilateral vestibular disease?
No head tilt No pathological nystagmus No vestibular ocular reflex Crouch low to the ground Fall to either side
What is the presentation of idiopathic vestibular disease and what is the prognosis?
Acute onset peripheral vestibular disease
Unilateral
Older dogs
Spontaneously recover - usually within 2-4 weeks
May be left with a residual head tilt
What is the clinical presentation of feline vestibular disease and what is the prognosis?
- Acute form - acute onset peripheral vestibular disease that improves in 2-4 weeks
- Atypical form - clinical signs progressive over 3 weeks
Recovery occurs over 3 months
What is the presentation of idiopathic facial and vestibular neuropathy and what must you make sure the owner does?
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
How should you investigate concurrent disease in vestibular diseases?
Haematology
Biochemistry
Thyroid panel
How should you investigate peripheral vestibular disease?
Examination of the ear canal and TM Swab for culture and sensitivity if TM broken Myringotomy if indicated Lavage Radiographs, CT or MRI
