What to Do if Your Dog Is Not Recovering from Vestibular Disease

This article was updated on May 1st, 2023

Being able to maintain balance is a pretty basic ability, so losing your footing makes life very difficult. The symptoms of vestibular disease can look pretty scary, and must feel awful for your dog, in particular when symptoms persist over time.

Most dogs recover from vestibular disease or show significant improvements within days. However, incomplete recovery from peripheral vestibular disease is fairly common: studies show that clinical signs can persist or even get worse over time for about 1 out of 3 dogs. This article will cover typical recovery times from vestibular disease and what you should do if your dog is not recovering.

Typical Recovery Time from Vestibular Disease in Dogs

Vestibular disease often arises spontaneously and, depending on the cause, usually resolves itself in the same way. Most dogs will start to improve within 2 to 4 days and will be totally recovered within two to four weeks. This study found that improvement was observed in 71% of cases after a median of 4 days after diagnosis.

More severe cases may take up to six weeks to be fully recovered. The most dramatic clinical signs of vestibular disease are evident within the first 24-48 hours and will usually begin to improve after this point.

Depending on the cause of vestibular disease, symptoms such as a head tilt and incoordination often disappear within the first 7-14 days, and many dogs will go on to make a full recovery within 2-4 weeks.

This is assuming that the cause of the vestibular disease is fairly benign, such as in the case of idiopathic vestibular disease or a middle/internal ear infection.

Dogs Who Do Not Recover Fully from Vestibular Disease / Vestibular Disease Getting Worse

The persistence of clinical signs can also be fairly common, with many dogs not recovering completely from an episode of vestibular disease. Vestibular disease may also get worse for some dogs. This study of 188 dogs with vestibular disease tracked the outcome with a median follow-up time of 12 months and found that:

1. Head tilt persisted for 34.5% of dogs (Head tilt is not generally a concern if the dog is otherwise well).
2. Symptoms of facial paresis persisted for 28.5% of dogs.
3. Incoordination when moving (ataxia) persisted for 4.1% of dogs.

Furthermore, 17.6% of the dogs in the study had recurring clinical signs at least once over the following 12-month period – meaning that even once symptoms resolved, there is a chance that they could recur in the future.

Incomplete recovery from peripheral vestibular disease is most notably common in dogs presenting with cranial nerve deficits and abnormalities detected on MRI.

What To Do If Your Dog Is Not Recovering from Vestibular Disease

If your dog shows no signs of improvement within the first 7 days, or if your dog appears to be getting significantly worse, then the next step is to investigate why this may be.

A dog that shows no improvement is suspected to have a more sinister underlying cause for their vestibular symptoms, and advanced imaging with CT/MRI scans are likely necessary. These more sinister causes are often grouped together under the term ‘central vestibular disease.’

One concern would be a lesion within the brain that had led to the unusual vestibular symptoms seen. This could be anything from inflammation and blood clots (stroke) to a tumor that is affecting the neurons involved in coordinating the vestibular system.

A specialist veterinarian is usually required to investigate further, so talk to your local veterinarian about a referral if necessary.

The most common causes of non-regressing vestibular disease are:

• Ischemic stroke: a blood clot in the brain cuts off blood supply to the nerves supplying the vestibular system.
• Neoplasia: The growth of a tumor that puts pressure on and damages the nerves supplying the vestibular system.

Some dogs that have a stroke will make a quick recovery, and their vestibular symptoms may subside within the first 1-2 weeks. However, if vestibular episodes keep recurring, then further investigations should be carried out.

Many dogs that suffer from strokes have another underlying cause that predisposes them to these repeated strokes, such as increased blood pressure, endocrine disease, blood clotting disorders, or kidney disease.

If this is the case, then blood tests should be performed to help rule some of these causes out.

Neoplasia is another possible cause of worsening vestibular disease, particularly in older dogs. However, this is still a rare cause of vestibular disease. Treatment options for a brain tumor depend upon the location and type of the tumor, but unfortunately, are limited.

Anti-inflammatory medication such as steroids can help to reduce the clinical signs but is by no means a cure. The median survival time for a dog with a brain tumor treated with steroids alone is between 2-4 months. This survival time can be increased through the implementation of chemotherapy and radiotherapy.

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