Vestibular disease (Canine) — NAVLE Prep

Quick anchor

Trigger

Head tilt, nystagmus, and falling/rolling

First step

Differentiate peripheral from central vestibular disease

Clue

Peripheral disease usually lacks major proprioceptive deficits

Trap

Vestibular ataxia is not the same as generalized weakness

Exam core — read this first

Classic presentation → head tilt, pathologic nystagmus, vestibular ataxia, and nausea

Localization question → central versus peripheral is the high-yield split

Peripheral clues → normal mentation and no significant postural-reaction deficits in many cases

Central clues → proprioceptive deficits, altered mentation, or vertical nystagmus raise urgency

Pattern recognition

Core pattern

Head tiltNystagmusVestibular ataxia / falling to one side

Supporting clues

Nausea or vomitingRollingFacial nerve signs possible in peripheral ear diseaseNormal strength despite imbalanceOlder dog with acute onset idiopathic syndrome

NAVLE trigger: The localization question comes first. “Vestibular disease” is only the starting label.

Decision core — what NAVLE actually asks

Vertical nystagmus, proprioceptive deficits, or altered mentation

→ Treat as central vestibular disease until proven otherwise

Acute peripheral-style vestibular syndrome in an older dog

→ Idiopathic peripheral vestibular disease stays high on the list after exam and ear assessment

Evidence of ear disease or cranial-nerve involvement

→ Peripheral otic disease becomes more likely and workup/treatment should follow that path

Key interpretation

Nystagmus

High yield

Direction and behavior help localization

Postural reactions

Check carefully

Central lesions often add deficits

Mentation

Usually normal in peripheral disease

Abnormal mentation is more concerning

Vertical nystagmus

Central red flag

Major board clue

Facial paralysis / Horner

Supports peripheral

Local ear/nerve involvement clue

Nausea

Common

Supportive care often needed even if lesion is peripheral

⚠ Head tilt alone does not make a case benign. Central signs change the entire urgency and differential list.

Treatment

Step 1

Localize the lesion and provide anti-nausea / supportive nursing care

Many vestibular dogs need help before they need a final label.

Step 2

Treat underlying ear disease when present

Peripheral vestibular disease is not always idiopathic.

Step 3

Escalate central vestibular cases to advanced neurologic investigation

Central localization changes the seriousness of the case.

NAVLE traps — where students lose marks

Vestibular ataxia is not generalized paresis

The dog is unbalanced, not necessarily weak.

Idiopathic old-dog vestibular disease is common, but it is still a diagnosis of pattern and exclusion

Do not ignore central red flags.

Vertical nystagmus is a major central clue

This is one of the most tested localization findings.

Peripheral disease can still look dramatic

Rolling and vomiting do not automatically mean brain disease.

Differentials — how to separate these on NAVLE

Fast separator: First separate peripheral from central vestibular disease; then ask whether ear disease, idiopathic peripheral disease, or brainstem disease fits best.

Problem	Mentation/postural reactions	Nystagmus clue	Key separator
Peripheral vestibular disease	Usually normal mentation / no major deficits	Horizontal/rotary common	Inner ear / vestibular nerve localization
Central vestibular disease	Deficits or altered mentation may be present	Vertical can occur	Brainstem/cerebellar localization
Seizure disorder	Post-ictal change	No persistent vestibular pattern	Different neurologic episode type
Cerebellar disease	Intention tremor / dysmetria	Not classic isolated vestibular syndrome	Different neuro localization clues
Orthopedic lameness	Normal neuro exam	No nystagmus/head tilt	Not a vestibular problem

30-second revision

PatternHead tilt + nystagmus + vestibular ataxia

High-yield splitPeripheral vs central

Central red flagsVertical nystagmus, deficits, mentation change

Peripheral clueNo major proprioceptive deficits

Critical trapDramatic rolling does not automatically equal central disease

Practice questions

Pre-built NAVLE-style · Vestibular disease

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Q1Recognition

Which clinical triad is most consistent with canine vestibular disease?

Q2Localization

Which finding most strongly suggests central rather than peripheral vestibular disease?

Q3Peripheral clue

Which statement is most accurate about peripheral vestibular disease?

Q4Management

What is an appropriate early management principle in a severely nauseated rolling vestibular dog?

Q5Trap question

Which statement about canine vestibular disease is most accurate?