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FEATURES JULY/AUGUST 2018 43 Symptomatic treatment is often beneficial as many patients that have vestibular disease experience varied degrees of severity of clinical signs including nausea, anorexia, anxiety, recumbency, circling, falling and rolling. For dogs that are mildly affected, meclizine, an antiemetic and antivertigo drug, is indicated. Other antiemetics such as maropitant, ondansetron or chlorpromazine can also be considered. Patients more severely affected will benefit from parenteral fluid therapy and intensive nursing care in an inpatient setting. During periods of severe vertigo (i.e., continuous rolling), these patients should be sedated to the point of relaxation; I prefer intermittent dosing or constant rate infusion of dexmedetomidine at a low initial starting dose (62.5 mcg/m2 IV). In addition, these patients need to be situated in as much of a "normal" posture as possible while still rotating the patient every 4 to 6 hours. Following the acute phase of vertigo, physical rehabilitation appears to aid in the recovery of ambulation and is recommended. SUMMARY Head tilt in dogs is generally mediated through dysfunction of the vestibular or cerebellovestibular system. Careful attention to history, progression of disease and a complete neurological examination, especially postural reaction testing and a cranial nerve examination, is paramount. Localization of whether the vestibular disease is of peripheral or central origin is essential to the accurate formation of a differential diagnoses for the patient. The underlying cause may be simple or more complex, with peripheral disorders typically carrying a better overall prognosis. References: 1. De Lahunta A, Glass E. Vestibular System: Special Proprioception. In: Veterinary Neuroanatomy and Clinical Neurology. 3 rd edition. St. Louis, MO: Saunders Elsevier; 2009:319-347. 2. Kent M, Platt SR, Schatzberg SJ. The neurology of balance: function and dysfunction of the vestibular system in dogs and cats. Veterinary Journal. 2010;185:247-258. 3. L owrie M. Vestibular Disease: Anatomy, Physiology and Clinical Signs. Compendium: Continuing Educa tion for Veterinarians. 2012;E1-E4. 4. Garosi LS, Dennis R, Pendaris J et al. Results of magnetic resonance imaging in dogs with vestibular disorders: 85 cases (1996-1999). Journal of the America Veterinary Medical Associa tion. 2001;218(3): 385-391. 5. Belmudes A, Pressanti C, Barthez P, et al. Computed tomographic findings in 205 dogs with clinical signs compatible with middle ear disease: a retrospective study. Veterinary Derma tology. 2018;29:45-e20. 6. Sturges BK, Dickinson PJ, Kortz GD, et al. Clinical signs, magnetic resonance imaging features and outcome after surgical and medical treatment of otogenic intracranial infection in 11 cats and 4 dogs. Journal of Veterinary Internal Medicine. 2006;20:648-656. 7. Schunk KL, Averill DR. Peripheral vestibular syndrome in the dog: a review of 83 cases. Journal of the American Veterinary Medical Association. 1983;182:1354-7. 8. Jeandel A, Thibaud JL, Blot S. Facial and vestibular neuropathy of unknown origin in 16 dogs. Journal of Small Animal Practice. 2016;57:74-78. 9. Higgins MA, Rossmeisl JH, Panciera DL. Hypothyroid-associated central vestibular disease in 10 dogs: 1999-2005. Journal of Veterinary Internal Medicine. 2006;20:1363-1369. 10. Lowrie M, Smith PM, Garosi L. Meningoencephalitis of unknown origin: investigation of prognostic factors and outcome using a standard treatment protocol. Veterinary Record. 2013;172(20):527. 11. Evans J, Levesque D, Knowles K, et al. Diazepam as a treatment for metronidazole toxicosis in dogs: a retrospective study of 21 cases. Journal of Veterinary Internal Medicine. 2003;17(3):304-310. 12. Thomsen B, Garosi L, Skerritt G. Neurological signs in 23 dogs with suspected rostral cerebellar ischaemic stroke. Acta Veterinaria Scandinavica. 2016;58:40. 13. Bentley RT, March PA. Recurrent vestibular paroxysms associated with systemic hypertension in a dog. Journal of the American Veterinary Medical Association. 2011;239(5):652-655. 14. Garosi L, McConnell JE, Platt SR, et al. Results of diagnostic investigations and long-term outcome of 33 dogs with brain infarction (2000-2004). Journal of Veterinary Internal Medicine. 2005;19:725-731. Michelle B. Carnes An Auburn University veterinary school graduate, Dr. Carnes interned at University of Missouri-Columbia. She completed her neurology/neurosurgery residency and received a Master's degree in biomedical science from Auburn University. In 2009, she received her ACVIM board certification in neurology and completed a canine rehabilitation course at University of Tennessee in Knoxville and advanced neurosurgical certification course in Las Vegas. She has presented research globally and is a founding member of the Veterinary Neurosurgical Society. Carnes serves as a reviewer for the American Journal of Veterinary Research. In 2009, Dr. Carnes and her husband, Eric, co-founded Florida Veterinary Neurology & Imaging Centers, which owns Specialists in Companion Animal Neurology (SCAN). Peripheral vestibular signs may develop if the ear has been flushed with any routine cleaning solution if the tympanum is ruptured.

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