bilateral vestibular? Otitis interna?

Re: bilateral vestibular? Otitis interna?

Mark Hedberg — Mon, 18 Nov 2013 13:49:22 GMT

[quote user="ilanit"]

I did the myringotomy and indeed it was no big deal And kitty woke up without facial paralysis or horner's syndrome!

Still waiting for inhouse culture results, but sensitivity already back and seems organism sensitive to all included antibiotics except Marbocyl!!

[/quote]

Well done, congrats!

Re: bilateral vestibular? Otitis interna?

ilanit — Mon, 18 Nov 2013 12:41:49 GMT

I did the myringotomy and indeed it was no big deal And kitty woke up without facial paralysis or horner's syndrome!

Still waiting for inhouse culture results, but sensitivity already back and seems organism sensitive to all included antibiotics except Marbocyl!!

Re: bilateral vestibular? Otitis interna?

Evelyn Barbour-Hill — Thu, 14 Nov 2013 16:26:15 GMT

Myringotomy is appallingly easy.

It's likely to provide some relief very quickly.

Re: bilateral vestibular? Otitis interna?

Mark Lowrie — Thu, 14 Nov 2013 15:29:19 GMT

I would tend to give amoxicillin and clavulanic acid (22 mg/kg bid) combined with metronidazole (15 mg/kg bid) or clindamycin (15 mg/kg bid) until specific bacterial sensitivity was available from culture and sensitivity. I should have mentioned in my previous post that metronidazole can cause these symptoms but you don’t mention that the cat has had this so not a worry if no history of this drug being given.

I would continue this for a minimum of 8 weeks if antimicrobial susceptibility testing was not performed or if it was negative. Having said all of this, if you can see pus then a myringotomy should be quite easy to perform as you can clearly see infection.

Regardless of whether this is idiopathic or otitis media/interna, symptoms will take a long time to resolve – weeks not days. Some patients will be left with permanent deficits but cope with normal day to day life perfectly well. Deterioration is the big concern and thing to monitor as this would go against idiopathic vestibular disease and suggests whatever you are doing is not working – though it is unlikely to alter what you do given further imaging is unavailable.

Re: bilateral vestibular? Otitis interna?

ilanit — Wed, 13 Nov 2013 20:13:49 GMT

[quote user="Mark Lowrie"]In summary, I would consider broad spectrum antibiotics in case of otitis media/interna (or a myringotomy if you are brave); thiamine supplementation in case of deficiency; and time in case this is idiopathic vestibular syndrome.[/quote]

What type of empirical antibiotics do you usually start with?

I guess I have to be brave and do the myringotomy to be able to do a culture.

Re: bilateral vestibular? Otitis interna?

ilanit — Wed, 13 Nov 2013 20:07:17 GMT

[quote user="Mark Lowrie"]I agree the cat looks like it may have bilateral vestibular dysfunction. The only thin against this is you suggest the cat has normal vestibular eye movements which are not commonly seen with bilateral vestibular disease although if one side is affected more than the other they may still be present to a degree.[/quote]

Thanks Mark.

I do not think the eye movements are normal. There might be some movement but very little.

Also there is puss against the right ear drum!

We might have given vitamin B for a couple of days, but I am not sure. In any case he's been eating normal kitten food for the last 3 weeks.

Wouldn't idiopathic vestibular disease have resolved by now?

Re: bilateral vestibular? Otitis interna?

ilanit — Wed, 13 Nov 2013 19:51:30 GMT

[quote user="Kate Richardson"]

has he always been like it or has it come on suddenly or do you not know?

[/quote]

I don't know. He was picked up on the street and brought to us about 3 weeks ago. A colleague had seen it and put it on antirobe for a week, with no effect. Now it has been on Marbocyl for 10 days, with equally little effect.

Re: bilateral vestibular? Otitis interna?

Martin Atkinson — Wed, 13 Nov 2013 17:01:38 GMT

[quote user="Mark Lowrie"]The only other disease to consider given it is a rescue cat would be thiamine deficiency. This causes central vestibular disease but with very focal brain lesions that can mean mentation is not majorly affected.[/quote] It is I believe possible to test for Thiamine deficiency (although I don't know where off the top of my head) but if the cat is now on normal cat food its Thiamine should be corrected. Presumably this cat would also be likely to have dilative cardiomyopathy if it had Thiamine deficiency. I diagnosed DCM in a young cat years ago when it was not possible to test for Thiamine. It has been on Thiamine + Fortekor ever since - the owner has been reluctant to take it off or perform the test and it is still going 12 years later.

Re: bilateral vestibular? Otitis interna?

Mark Lowrie — Wed, 13 Nov 2013 16:27:09 GMT

I agree the cat looks like it may have bilateral vestibular dysfunction. The only thin against this is you suggest the cat has normal vestibular eye movements which are not commonly seen with bilateral vestibular disease although if one side is affected more than the other they may still be present to a degree.

The next step is to determine whether tis central or peripheral. I think peripheral is most likely as the cat is otherwise bright and alert and a lesion to cause bilateral central vestibular disease would most likely result in a stupor/coma.

Otitis media/interna and idiopathic vestibular syndrome are the two most common causes for cats with peripheral vestibular dysfunction. Although the young age of the cat (you don’t specify the age) is unusual. The only other disease to consider given it is a rescue cat would be thiamine deficiency. This causes central vestibular disease but with very focal brain lesions that can mean mentation is not majorly affected.

In summary, I would consider broad spectrum antibiotics in case of otitis media/interna (or a myringotomy if you are brave); thiamine supplementation in case of deficiency; and time in case this is idiopathic vestibular syndrome. Of course weird diseases do occur and if the symptoms progress we are in the territory of storage diseases and other serious conditions but then the prognosis for them is grave.

Re: bilateral vestibular? Otitis interna?

Kate Richardson — Wed, 13 Nov 2013 14:53:20 GMT

I agree with you Ilanit, it looks very similar to the Cornell video. I am not a neurologist by any means, hopefully Mark Lowrie can comment. I have never seen a cat or kitten with cerebellar hypoplasia, but looking at videos it does look different to your kitty. has he always been like it or has it come on suddenly or do you not know? Cerebellar hypoplasia kittens are like it from birth. http://www.youtube.com/watch?v=xLlL24shW7E

Re your other case with the bulging ear drum, I think you have to be brave and perform a myringotomy or bullae osteotomy as it will not resolve unless you release the infection/inflammation. Have you got the cat on anti-inflammatories as well as antibiotics?

Re: bilateral vestibular? Otitis interna?

ilanit — Wed, 13 Nov 2013 06:18:03 GMT

No, on Malta, so quite unlikely.

He was a bit aggressive in the beginning, but now that he got used to us he's actually quite a sweet kitty. Apart from the gait/movement he seems normal.

Re: bilateral vestibular? Otitis interna?

mariette asselbergs — Tue, 12 Nov 2013 21:51:31 GMT

Scary, my thought would be rabies until proven otherwise. Are you in the UK? What makes me think of rabies are the frantic "driven" aimless pacing and walking. The suggestion of wanting to get to something but not really following this purpose. If this kitten becomes either aggressive or paralysed or starts drooling and dies then have it diagnosed for rabies.

Mariette

Re: bilateral vestibular? Otitis interna?

ilanit — Tue, 12 Nov 2013 14:57:22 GMT

I must admit it was my first thought too in an ataxic young kitten, but the gait doesn't show any hypermetria, it's more a bit 'crouched'. Also menace reflexes are normal.

The head movements look very much like these to me, but maybe I am wrong:

http://www.neurovideos.vet.cornell.edu/Video.aspx?vid=12-17

I'll have another look when he has his breakfast tomorrow :)

Re: bilateral vestibular? Otitis interna?

Anthony Dennison — Tue, 12 Nov 2013 14:06:19 GMT

+1 for cerebellar hypoplasia, especially in a charity case kitten. What is it like when it eats? Lot's of head bobbing/missing the bowl?

Re: bilateral vestibular? Otitis interna?

Kirsten Simpson — Tue, 12 Nov 2013 10:35:18 GMT

It looks almost like Cerebellar Hypoplasia to me? Although I've only ever seen one adult cat with it, this would be my firth though in this kitten. I may well be wrong! Its the wide based stance when he walks/mild ataxia although its not as bad looking as some videos of kittens with CH I've been looking at just now. Hmmm interesting case!