Vestibular syndome - cat???

Re: Vestibular syndome - cat???

Mark Hedberg — Mon, 07 Oct 2013 11:27:46 GMT

[quote user="Gillian Mostyn"]

the booby prize for me...!!!

[/quote]

I'm a multiple winner of that award myself!

Re: Vestibular syndome - cat???

Anthony Dennison — Mon, 07 Oct 2013 10:39:19 GMT

[quote user="Gillian Mostyn"]5 gold stars to Chestergates [/quote]

Agree with you on this one. Anything neurological that owners are willing to work up I send there, the team is fantastic. Plus they're very good at answering all my stupid questions!

Re: Vestibular syndome - cat???

Gillian Mostyn — Sun, 06 Oct 2013 09:10:05 GMT

[quote user="Mark Lowrie"]

this sounds very likely a peripheral vestibular problem form your description and yes, cats do get idiopathic vestibular disease. However, as with any idiopathic condition, it is sensible to rule-out other causes of peripheral vestibular disease doing advanced imaging e.g. ear disease.

[/quote]

Note to self..... next time do what the expert tells you to do.....

Mizzle's MRI pictures showed otitis media - her tympanic bullae (according to owner) were 'full of gunk'. She had surgery to flush them out on Friday and came home yesterday. Immediate transformation - much happier (non-wonky) cat and very happy owner. 5 gold stars to Chestergates .... and the the booby prize for me...!!!

Re: Vestibular syndome - cat???

Gillian Mostyn — Wed, 02 Oct 2013 23:00:16 GMT

hmmm.... the owner (my receptionist) thinks she's had a few days recently where her ataxia and head tilt has been a bit worse so we've decided to sent her to a local referral practice (Chestergates) for a neuro exam.... she's there tomorrow so I'll let you know how it goes!

Re: Vestibular syndome - cat???

Gillian Mostyn — Thu, 26 Sep 2013 13:00:29 GMT

Final (hopefully) case update...

Mizzle is back to normal apart from a slight head tilt.

Re: Vestibular syndome - cat???

Gillian Mostyn — Wed, 14 Aug 2013 22:54:57 GMT

OK, update:

Mizzle is now doing well. She actually developed a flu-like illness a few days later (when I was away on holiday) for which she received TLC and antibiosis. No idea if this was related to the initial problem or whether it simply happened (or was contracted) while she was hospitalised. This resolved and she has been left with a mild head tilt and occasional balance issues but is otherwise back to her normal self. The neuro issues do still seem to be slowly improving.

So I still have no idea what was wrong with her!

Re: Vestibular syndome - cat???

Mark Hedberg — Fri, 19 Jul 2013 09:11:29 GMT

[quote user="GrooveJet"] BUT today we received Toxoplasma serology results back: through the roof!!! Both IgG and IgM. Of course there's no way to prove a link, but got to be suspicious, no?

[/quote]

Well, it would be, wouldn't it? as neurological signs are a symptom of clinical toxoplasmosis in cats...

Re: Vestibular syndome - cat???

mariette asselbergs — Thu, 18 Jul 2013 23:44:31 GMT

Thanks very much for your comments Mark!

Her nystagmus was definitely horizontal and lasted for about 2.5 days. She is now back to normal with the exception of still keeping her head a bit tilted.

Mariette

Re: Vestibular syndome - cat???

Miriam Lodewyks — Thu, 18 Jul 2013 23:05:58 GMT

Interesting to read your OP, as I've just had an almost identical experience, and like you, was a little surprised to find it happening to a previously fit and healthy cat. 4 days on, the nystagmus is almost resolved, but the head tilt remains. Cat seems comfortable and eating well. Surprisingly, no vomition or signs of nausea were noted. Bloods fairly normal apart from mild anaemia (26%), BUT today we received Toxoplasma serology results back: through the roof!!! Both IgG and IgM. Of course there's no way to prove a link, but got to be suspicious, no?

Re: Vestibular syndome - cat???

james herriot lied — Thu, 18 Jul 2013 22:36:06 GMT

[quote user="Mark Lowrie"]

You are right Anthony – vertical nystagmus means central vestibular disease. Rotatory and horizontal nystagmus could pertain to either peripheral or central vestibular disease and so aren’t as useful in localising but do confirm vestibular disease.

[/quote]

Ah well, that's all my theories gone for a burton, then. I'll get me coat.......

Re: Vestibular syndome - cat???

Gillian Mostyn — Thu, 18 Jul 2013 21:54:28 GMT

Update for those interested:

Bloods all WNL

Mizzle (the cat) is now eating and drinking ok and more steady on her feet. Her nystagmus has reduced although she isn't 'right' yet.

Looks like a vestibular episode, thank goodness, so no plans at the moment to send for scans. I have to hand her care over to a colleague now as off on hols for 2 weeks tomorrow but I will post another update when I get back.

Re: Vestibular syndome - cat???

Mark Lowrie — Thu, 18 Jul 2013 11:16:40 GMT

Re: Vestibular syndome - cat???

Neil Wheadon — Wed, 17 Jul 2013 22:28:11 GMT

[quote user="tess"]Anyone use Cerenia for those who are vomiting?[/quote]

As Churchill the dog says 'Oh yes'

The posh name is 'Paroxysmal Positional Vertigo

Symptoms - Wake up in the morning having driven back from France, the room spins 180 degrees (now that's weird) you vomit and desperately try to keep still and you get nystagmus.

I got referred when farmers laughed at me when I bent over to wash my boots and fell over!!

The manoevre is called the modified Epley manoevre. It places your Otolithes back in the right place apparantly, try that on a cat if you can.

I was amazed at just how many people suffer from this. Thankfully it was 3 years ago and no recurrance.

Every animal I see gets cerenia as the nausia is awful

Neil

Re: Vestibular syndome - cat???

Hanna Bennett — Wed, 17 Jul 2013 18:58:38 GMT

had one like this except the owner reported that the cat was unresponsive to them while circling and confused - no nystagmus reported so was unsure if it was vestibular or central - back to normal the next day but o very concerned it will happen again

Re: Vestibular syndome - cat???

james herriot lied — Wed, 17 Jul 2013 18:35:48 GMT

[quote user="Anthony Dennison"]

Mark, I'm under the impression that one of the ways to determine whether vestibular disease is central or peripheral is to check for vertical nystagmus. If it is present, it is almost always central. Is this true?

[/quote]

My understanding is that rotational nystagmus is more likely to indicate central vestibular disease - although I have to say, if I see it it doesn't tend to alter the initial work-up. Making the owners understand that the next three days are likely to be really ropey helps - and then and only then would I start to prognosticate (nearest MRI 170 miles away).

Re: Vestibular syndome - cat???

tess — Wed, 17 Jul 2013 18:31:36 GMT

I've had this too. Labyrinthitis they called it. I woke up one morning unable to stand, vomiting, dizzy etc. It truly is the worst thing. A friend gave me a lift to the docs who looked really surprised to see me because "we normally do house visits for this condition, it's so bad" (but we won't go there). Buccastem (prochlorperazine) helped but it took 2 weeks before I was better and for about a month after I still occasionally felt sick if I moved too quickly. Some people live with it which must be soul destroying.

I tend to give a low dose ACP to dogs in initial presentation, if nothing else than to stop them crashing around, and to help with the nausea. Anyone use Cerenia for those who are vomiting?

Re: Vestibular syndome - cat???

Rob Reid — Wed, 17 Jul 2013 18:29:08 GMT

I've seen similar acute clinical signs to the OP case in a couple of cats. One of them work-up revealed nothing and it resolved within a few days so I put it down to being a vestibular disease.

The other had an airgun pellet lodged in it's bulla and resolved after surgery!

Re: Vestibular syndome - cat???

Anthony Dennison — Wed, 17 Jul 2013 16:57:26 GMT

Re: Vestibular syndome - cat???

Mark Lowrie — Wed, 17 Jul 2013 15:36:07 GMT

[quote user="mariette asselbergs"]

[/quote]

You raise a really good point. Many dogs that have an acute onset of idiopathic vestibular disease look terrible and often these dogs are best nursed away from the owners for 2-3 days as PTS is not uncommon simply based on the dramatic presentation. However, the distinction as to whether the vestibular signs are peripheral or central is far more important than their severity (in fact the initial severity has no bearing on prognosis other then it seems to make people consider euthanasia sooner than they should).

[quote user="mariette asselbergs"]

But improving from the 3rd day on and then quite dramatically back to normal.

[/quote]

And by simple nursing and not much else you get these dramatic improvements in a short time.

[quote user="mariette asselbergs"]

What is supposed to be the cause of vestibular syndrome? can it be a stroke in an area where the brain more easily "re-wires"

[/quote]

It is more commonly know as idiopathic vestibular disease and sadly therein lies the answer. We don’t know the cause, we just know they do fantastically well when given time.

Cerebrovascular accidents (strokes) do cause vestibular signs but the symptoms would more commonly relate (not always) to central vestibular disease and not peripheral vestibular disease (e.g. idiopathic vestibular disease).

I do think a lot of dogs diagnosed with idiopathic vestibular disease without MRI potentially have suffered a cerebrovascular accident.

[quote user="mariette asselbergs"]

She also has mitralis insufficiency with heartmurmurs 4/6 but no clinical signs of congested heart failure other than lack of energy and stamina, I was thinking that she might have had an embolus from the mitralis valves?

[/quote]

In your dog’s case Mariette I am not sure whether this was a stroke or an idiopathic vestibular disease. Were there symptoms that suggested a peripheral or central disease? The fact your dog has a heart condition means an embolus may have resulted in a cerebrovascular accident but hard to say based on your description above.

Re: Vestibular syndome - cat???

mariette asselbergs — Wed, 17 Jul 2013 11:24:41 GMT

Thanks for bringing up this interesting case!

My own 13 year old English bull terrier had a severe episode just 2 weeks ago and it was good to see how dreadfully ill they can be, I myself considered PTS on the 2nd day, thinking this cannot "just" be the old dog vestibular syndrome. Sudden onset, severe torticollis and nystagmus, total loss of balance, unable to get up, eat or drink except when being handfed little slivers of chicken or ham. But improving from the 3rd day on and then quite dramatically back to normal. She also has mitralis insufficiency with heartmurmurs 4/6 but no clinical signs of congested heart failure other than lack of energy and stamina, but is on vetmedin which helped a lot.

What is supposed to be the cause of vestibular syndrome? can it be a stroke in an area where the brain more easily "re-wires", or maybe better: finds alternative ways of restoring sense of balance? I was thinking that she might have had an embolus from the mitralis valves?

Interesting idea of manipulating of loosened debris in the vestibular canals!

Will follow your case story.

Mariette

Re: Vestibular syndome - cat???

Gillian Mostyn — Wed, 17 Jul 2013 10:55:34 GMT

Thank you very much Mark - there is no change this morning so the plan is bloods and TLC for 24 hrs and then reassess.

Re: Vestibular syndome - cat???

Laurence Webb — Wed, 17 Jul 2013 10:37:01 GMT

Ah here it is... http://en.wikipedia.org/wiki/Epley_maneuver

Google and Wikipedia - the source of most of my knowledge!

Re: Vestibular syndome - cat???

Laurence Webb — Wed, 17 Jul 2013 09:21:11 GMT

[quote user="glen mcintosh"]As an aside, has anybody had acute vestibular disease themselves? [/quote]

No, but a friend had an episode whilst at my house. She had been absolutely fine and had a sudden (and I mean sudden!) onset of symptoms. Fell over, vomiting, nystagmus, the lot. The assumed cause was some debris or crystals in the semilunar canals becoming dislodged. Symptoms settled after a few days but she was completely incapacitated during that time.

Whilst using Dr Gogle to find out about it I discovered that the debris can be relocated into a benign place by a set series of manipulations (lying on the back, rotating to one side so many degrees then in another direction etc). I have no idea if this is the case in cats! If I can find it then I'll let you know. May be worth a go just out of interest if you have the cat sedated or under anaesthetic for imaging.

Re: Vestibular syndome - cat???

Mark Lowrie — Wed, 17 Jul 2013 09:07:20 GMT

Hi Gillian

Apologies for the quick reply as caught between cases but this sounds very likely a peripheral vestibular problem form your description and yes, cats do get idiopathic vestibular disease. However, as with any idiopathic condition, it is sensible to rule-out other causes of peripheral vestibular disease doing advanced imaging e.g. ear disease.

Anyhow, if this is idiopathic then the cat should do really well and hopefully will improve markedly within days. May take a lot longer to return to normal though.

Re: Vestibular syndome - cat???

Gillian Mostyn — Wed, 17 Jul 2013 07:55:05 GMT

The cat belongs to a staff member (don't they always?) so I know her very well. She was AOK until yesterday afternoon/evening, has had no previous health problems, has not lost any weight recently and is still bright despite her symptoms. Temp normal. She will be having bloods and any other diagnostics she needs today but I am not expecting to find any underlying issues such as renal disease. Obviously I will check though.

Thanks for all the ideas. I really can't remember ever seeing such severe nystagmus in an otherwise well cat, except for very obvious otitis cases. It is reassuring that others have as I was thinking it wasn't looking good......

Cost isn't an issue as she is much loved and well insured so will see what today brings.