Neurological examination correctly identifies central vestibular disease in 98.4% of dogs but misclassifies peripheral disease as central in 22.6% of cases, making MRI essential when a dog with apparent peripheral signs fails to improve promptly.Journal of Smal…

The key differentiating signs on neurological examination are those indicating central involvement. Central vestibular disease is characterized by proprioceptive deficits, altered mentation, cranial nerve deficits other than CN VII or VIII, and vertical or dysconjugate nystagmus.Journal of Vete… Peripheral vestibular disease produces head tilt, ataxia, nystagmus (typically horizontal or rotary), positional strabismus, and — when the lesion is at the level of the petrous temporal bone — concurrent ipsilateral CN VII deficits and Horner syndrome.BMC Veterinary…+1 Approximately 20% of dogs with a suspected peripheral neurolocalization on examination are subsequently found to have intracranial disease on MRI, reinforcing that examination alone is insufficient for definitive localization.Journal of Vete…

A modified penlight-cover test can add bedside support for peripheral localization. Removing visual input by shining a penlight into one eye while covering the other increases nystagmus beat frequency in 33% and slow phase velocity in 24% of dogs with confirmed peripheral lesions, while only 1 of 16 dogs with central lesions showed any increase in beat frequency and none showed increased slow phase velocity.Journal of Vete… A positive result (increased beat frequency or slow phase velocity) raises suspicion for peripheral disease when interpreted alongside the full neurological examination.Journal of Vete…

In geriatric dogs, idiopathic vestibular syndrome (IVS) is the most likely diagnosis, followed by otitis media/interna and, less commonly, hypothyroidism, neoplasia, and cholesteatoma.BMC Veterinary… Increasing age is associated with a diagnosis of IVS rather than otitis media/interna.BMC Veterinary… The prevalence of vestibular disease in dogs aged 9 years or older reaches 0.36% in primary care, compared with 0.08% overall.BMC Veterinary…

CSF analysis does not reliably differentiate central from peripheral vestibular disease and should not be used as the sole diagnostic technique. Elevated total nucleated cell count (TNCC) has a sensitivity of 49% and specificity of 90% for identifying central disease, while elevated total protein has a sensitivity of 58% and specificity of 39%.Veterinary Reco… Meningoencephalitis of unknown origin is associated with lymphocytic pleocytosis, whereas IVS and ischemic infarct are associated with activated macrophages or normal cytology.Veterinary Reco…

Expected recovery depends on the underlying cause and MRI findings. IVS is a benign, self-limiting condition that generally resolves spontaneously within a few weeks.BMC Veterinary… However, incomplete recovery is common across peripheral vestibular disease as a whole: persistent head tilt occurs in 50 of 188 dogs, persistent facial paresis in 41, and persistent ataxia in 6 at long-term follow-up.BMC Veterinary… Recurrence of clinical signs is observed in 26 of 188 dogs.BMC Veterinary… A prior history of vestibular episodes is associated with an increased likelihood of full resolution of signs, while contrast enhancement of CN VII and/or CN VIII on MRI is associated with a decreased chance of resolution.BMC Veterinary… MRI is recommended when a dog with apparent peripheral signs does not rapidly respond to treatment, given the 22.6% rate of peripheral mislocalization on examination alone.Journal of Smal…

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