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Dr. Kara
Dr. Kara, Veterinarian
Category: Dog
Satisfied Customers: 17944
Experience:  Over 20 years of experience as a veterinarian.
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Our small yorkie jack is holding vhis head slightly on one

Customer Question

Our small yorkie jack is holding vhis head slightly on one side and has a slight problem with balance. This has only just happened and wondered whether it is caused by some foreign body (possibly grass seed in his ear - we have looked but nothing obvious and no discharge or smell in either ear) or whether it might be something more serious such as a small stroke. He is 6 yeras old.
Submitted: 3 years ago.
Category: Dog
Expert:  Dr. Kara replied 3 years ago.
Hello, my name is Dr. Kara and I have over 20 years of experience as a veterinarian. I am so sorry to hear about your fellow's head tilt and slight problem with balance. A stroke in dogs is extremely rare, and especially in such a young dog I don't think that is the trouble.

What other symptoms is he having?
When he tries to walk is he circling?
Does he have rhythmic back and forth or circular eye movement? (like this dog : )
Is he very nauseous such that he is vomiting or is he not eating well?
Does he have a history of previous ear infections?

A dog with balance trouble and a head tilt usually has vestibular disease.
Vestibular disease is a disturbance in the balance system. It can be due to a problem in the middle ear or along the pathways that send information from the middle ear to the brain or in the brain itself. Dogs with vestibular disease feel like they have just stepped off a merry-go-round, very dizzy and nauseous and the more they try to move the worse they feel.

There can be several causes of vestibular disease. They range from very benign causes such as idiopathic (meaning we don't know the cause but they resolve on their own with supportive care) to middle ear infections or polyps, brain infections (bacterial, fungal or viral) or even a primary brain lesion such as a blood clot, bleeding or a tumor.

If we cannot identify a cause then we will often treat the patient symptomatically (antinausea drugs, anti-inflammatories and antibiotics) as most dogs do get better with supportive care.

Prognosis if this is caused by a lesion outside the brain is very good in most cases. We can check blood tests to make sure organ failure or low thyroid hormone are not the cause of his symptoms.

At home now you can give Gravol also known as Dramamine (dimenhydranate) to control nausea, which is also used for carsickness. The dose is 4mg to 8mg per pound of body weight every 8 hours. Side effects are mild sleepiness and dry mouth.
Or you can try Benedryl (diphenhydramine) at 1mg per pound of body weight orally every 8 hours. Side effects are sedation and dry mouth as well.

To stimulate his appetite start a bland diet of 1/3 boiled, lean hamburger (or boiled, white skinless chicken), all fats and juices drained off the meat, mixed with 2/3 boiled, plain white rice. Feed several small meals a day.

If he is so nauseous he refuses to eat anything or begins vomiting he needs injectable antinausea drugs and fluids to support him until he can eat on his own.

If after a week’s time there is no improvement or if he is worse then he needs further diagnostics to try and identify the cause. Serious central nervous system (the brain) causes are more likely and thus prognosis is much more guarded.

Things such as an MRI or spinal tap are indicated at that point.
If he is not improving a referral to a neurologist is best as they can perform this advanced testing.
Please see this link if you would like to read more about vestibular disease:
Please let me know if you have any further questions.
Customer: replied 3 years ago.

Thank you for your helpful advice. He does not have nausea nor is he circling as you ask in your advice. He is slightly off his food , otherwise he appears lively. He has always shaken his head from side to side before and after a wlk and still continues to do so. Thank you for advising that you dont think it would be a mini stroke particuloarly due to his relatively young age We shall see our vet locally if the symptons persist

Expert:  Dr. Kara replied 3 years ago.
I am sorry I missed your reply last night. For whatever reason it didn't come through to me until this morning.
I am glad that he doesn't seem nauseous but if he is slightly off his food I suspect that he is feeling a little dizzy and nauseous, just not enough to vomit. Either of the medications I recommended may help with both his dizzy feeling and decreased appetite.
I am not so concerned about his head shaking if that has been a long term behavior.
Please let me know how he progresses, or if you have any further questions.