Central or peripheral vestibular syndrome in the dog
10-year-old crossbred dog with a left head tilt and falling to that side for 4 days, worsening.
| Parameter | Result | Reference |
|---|---|---|
| Mental status | Obtunded | Alert |
| Nystagmus | Vertical; changes with head position | Absent |
| Postural reactions | Delayed in left limbs | Normal |
| Facial sensation | Reduced on the left side | Normal |
What type of vestibular syndrome does it have?
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A. Left peripheral: idiopathic geriatric vestibular disease
This is the most common trap. In the idiopathic form the nystagmus is horizontal or rotatory, the dog is disorientated but not obtunded, there are no postural deficits and it improves within days.
B. Left central
Correct. Obtundation, ipsilateral postural deficits, vertical nystagmus that changes direction with head position and a deficit in another cranial nerve (CN V) indicate brainstem involvement.
C. Left peripheral due to otitis media-interna
Otitis media-interna can be associated with Horner syndrome or facial paralysis, which travel through the middle ear, but not with obtundation, vertical nystagmus, postural deficits or a trigeminal deficit.
D. Paradoxical vestibular syndrome with a right-sided lesion
In paradoxical syndrome the tilt is away from the lesion, whose side is identified by the postural deficits. Here the tilt and the deficits are on the same (left) side.
lightbulb Key takeaway
Central vestibular signs: altered mental status, postural deficits, vertical or direction-changing nystagmus and deficits in cranial nerves other than VII and VIII. In an older dog consider neoplasia, infarction or inflammation: MRI is the test of choice. Do not forget metronidazole toxicity.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.