Neurology: vestibular disease

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  • Cause : damage to the vestibular system which is responsible for maintenance of the normal orientation of the trunk, limbs and eyes with respect to the position and movements of the head.
  • Signs : disturbed equilibrium and ataxia, without paresis.
  • Diagnosis : history and clinical signs (exacerbated by blindfolding).
  • Treatment : appropriate treatment of the primary cause of the vestibular damage.
  • Prognosis : guarded - affected animals often centrally accommodate with time and can return to their previous function, although signs can still be elucidated by blindfolding.


Differential diagnosis


Clinical signs

  • All signs are exacerbated by blindfolding the animal.


  • Peripheral disease:
    • True head tilt towards affected side, ie ventral deviation of the poll to the affected side.
    • Spontaneous rotary or horizontal nystagmus with the fast phase away from the affected side.
    • Ipsilateral ventrolateral strabismus.
    • Head elevation.
    • Staggering dysmetric gait with a tendency to lean or circle towards the affected side.
    • Extensor hypotonia ipsilateral to lesion.
    • Hyperextension of contralateral limbs.
    • Asymmetrical ataxia.
    • Malfunctioning righting reflex    →   exaggerated attempts to stand.
    • Clinical signs of cranial nerve VII dysfunction if concurrently affected. Twisted muzzle, droopy ear, corneal ulcer, inability to shut eye, foul breath due to paralysis of the buccinator muscle.
    • Clinical signs of cranial nerve VIII and IX in cases of skull fracture secondary to temporohyoid osteoarthropathy.
    • Difficulty in eating.
  • Central disease:
    • Variable nystagmus: horizontal, rotatory or vertical.
    • General proprioceptive deficiencies.
    • Head tilt towards or away (rare) from lesion.
    • Depression.
    • Frequently adjacent brainstem structures are involved    →   other signs:


  • Dysmetria.
  • Severe, more symmetric, ataxia.
  • Wide, swinging head movements.
  • Deafness if cochlear branch of cranial nerve VIII is involved bilaterally.



  • Guarded: affected animals often centrally and visually accommodate with time and can return to their previous use, although vestibular function deficits can still be elucidated by blindfolding.
  • If blindness is present the prognosis worsens because of the loss of visual compensation for vestibular malfunction.
  • Associated facial and other cranial nerve deficits often remain, with only slight improvement over time. If even mild improvement of facial nerve function is noted in the first 4 months, full function may return.
  • Early removal of toxic fodder can   →   a complete recovery from mycotoxicosis over a period of a few days to several weeks.

Extreme care should always be taken when riding animals with vestibular disease: reduced light situations can instigate a rapid return of clinical signs or cause increased anxiety in the horse, which could be dangerous to the rider.

Expected response to treatment

  • Affected animals often centrally accommodate with time.
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