Vestibular syndrome

Question 1

Prevalence

Answer 1

• very common in practice

Question 2

CS

Answer 2

• heat tilt towards the side of the lesion
• circling towards the side of the lesion
• nystagmus (slow towards the side of the lesion, fast away from the side of the lesion)

Question 3

What are all vestibular cases considered until further signs? What are these signs?

Answer 3

• all vestibular cases are considered peripheral unless you see signs to make them central
• central lesions will show the same signs + other neurological signs such as prioprioceptive deficits or other CN involvement (except VII facial)

Question 4

Investigation

Answer 4

• need to do a thorough neurological exam including other CN to determine if isolated peripheral vestibular or central (indicated when other neurological deficits other than vestibular are seen, esp proprioceptive deficits). if central then it is not idiopathic facial paralysis but needs consideration for other brain pathologies
• don’t forget to do an otoscopic examination to exclude evidence of otitis media or nasopharyngeal polo (which also may need careful exam of caudal pharynx under GA)

Question 5

Anatomical consideration

Answer 5

• the facial nerve enters the skull in the internal acoustic meatus alongside the vestibulococlear nerve -> idiopathic facial nerve and vestibular syndrome often seen concurrently

Question 6

What is peripheral vestibular syndrome commonly caused by?

Answer 6

• idiopathic vestibular syndrome
• old dog vestibular syndrome
• otitis interna
• nasopharyngeal polps

Question 7

What is peripheral vestibular syndrome rarely due to?

Answer 7

• metronidazole toxicity
• thiamine deficiency in the cat

Question 8

Peripheral vestibular syndrome tx

Answer 8

• often will improve without significant intervention

Question 9

Prevalence of idiopathic vestibular syndrome

Answer 9

• very common

Question 10

Diagnosis of idiopathic vestibular syndrome

Answer 10

• by exclusion

Question 11

Tx of idiopathic vestibular syndrome

Answer 11

• no specific tx has been shown to work
• steroids are controversial and usually not indicated
• if nausea is a significant part of presentation can try anti-emetic therapy

Question 12

Prognosis of idiopathic vestibular syndrome

Answer 12

• on conservative therapy is good, but may be left with long term residual deficits

Question 13

What is old dog vestibular syndrome

Answer 13

• a form of idiopathic vestibular syndrome presenting in old dogs

Question 14

Presentation of old dog vestibular syndrome

Answer 14

• often present with severe signs including inability to stand and rolling

Question 15

Tx and prognosis of old dog vestibular syndrome

Answer 15

• as per idiopathic