Figure 1: This dog has a head tilt
A persistent head tilt is a sign of a balance (vestibular) centre problem in dogs. It is very similar to ‘vertigo’ in people and is often accompanied by a ‘drunken’ walk and involuntary eye movements, either side to side or up and down.
The feeling that the room is spinning due to the eye movements is what causes a feeling of nausea in both people and dogs. The signs may not be as severe as mentioned here and can just consist of a mild head tilt. Signs often seen associated with a head tilt but unassociated with balance abnormalities include a facial ‘droop’ and deafness.
Causes of a head tilt A head tilt represents a disorder of the balance centre. However, the balance centre resides in the inner bony portion of the ear as well as the brain. So a head tilt could represent a simple ear problem or a very serious brain disease.
Ear problems which are responsible for head tilts include:
Infections
Polyps
Reactions to topical drops or solutions if the ear drum is damaged
Hits to the head
(Occasionally) ear tumours
(Rarely) a genetic abnormality affecting puppies, especially those of the Doberman breed
Idiopathic vestibular disease
The most common cause, is what is called idiopathic vestibular disease . There is no known cause of this disease, a variant of which is also seen in people. The signs can start very suddenly and be accompanied by vomiting in severe cases. This condition, however, will resolve given time without any specific treatment.
Brain diseases responsible for balance centre dysfunction can include:
Tumours
Trauma
Inflammation
Stroke
Rarely, similar signs can be seen in dogs that are receiving a specific antibiotic called metronidazole. Recovery will often take place within days of stopping this medication.
Clinical signs of vestibular disease – is it the ear or is it the brain? In addition to a head tilt, signs of vestibular disease (balance centre dysfunction) include ataxia (a drunken, falling gait) and nystagmus (involuntary eye movements). There are several signs to look for which help separate out whether the origin of the disease is inner ear or brainstem (central nervous system; CNS).
Figure 2: This dog is showing loss of muscle over the head associated with disease of the central nervous system
Central nervous system localisation will often be associated with weakness on one side of the body that can manifest as ‘scuffing’ or even dragging of the legs, in addition to lethargy, and sometimes problems eating and swallowing, or loss of muscle over the head.
A balance problem associated with an inner ear disease is not likely to be associated with any of these signs. However, some dogs will exhibit a droopy face and a small pupil on the same side as the head tilt.
Tests recommended for a dog with a head tilt Evaluation of an animal with a head tilt includes physical and neurologic examinations, routine laboratory tests, and sometimes x-rays. Your veterinary surgeon may carry out a thorough inspection of the ear canal, which may require sedation of your dog – this can be useful to rule out obvious growths or infections. Additional tests may be recommended based on the results of these tests or if a metabolic or toxic cause is suspected. Identification of specific brain disorders requires imaging of the brain, such as magnetic resonance imaging (MRI). Collection and examination of cerebrospinal fluid, which surrounds the brain, is often helpful in the diagnosis of certain inflammations or infections of the brain.
How do we treat head tilt in dogs? Treatment for vestibular dysfunction will focus on the underlying cause once a specific diagnosis has been made. Supportive care consists of administering drugs to reduce associated nausea and or vomiting. Over the counter travel sickness drugs can be very effective. These must only be given following advice from your veterinary surgeon, however. Protected activity rather than restricted activity should be encouraged as this will potentially speed the improvement of the balance issues.
Figure 3: This dog has such severe vestibular disease that he is unable to stand upright
Outlook (prognosis) for head tilt in dogs Prognosis depends on the underlying cause. Prognosis is good if the underlying disease can be resolved and guarded if it cannot be treated. Prognosis for animals with idiopathic vestibular disease is usually good, because the clinical signs can improve within a couple of months.
About Simon Platt
Simon is Professor of Veterinary Neurology at The University of Georgia School of Veterinary Medicine and previously Head of Neurology at The Animal Health Trust in Newmarket. He is a Diplomate of both The European College of Veterinary Neurology and The American College of Internal Medicine.
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