Your 13-year-old Beagle, Buster, woke up with a head tilt, falling to one side, and rapid eye movements. He's vomiting and can't walk straight. It came on suddenly. Is it a stroke?
Peripheral (old dog vestibular syndrome): idiopathic, inner/middle ear. Head tilt, horizontal nystagmus, ataxia, vomiting. No limb weakness, no mentation change. Usually improves in days to weeks. Central (brainstem): vertical or changing nystagmus, limb weakness, mentation changes—more concerning. The Neurology Specialist explains: Acute peripheral vestibular in a senior dog is often idiopathic—supportive care. Central signs warrant MRI.
Supportive care: antiemetics (maropitant, meclizine), nursing care, prevent injury from falling. Most peripheral cases improve over 1–2 weeks. Residual head tilt may persist. The Vital Signs Reference helps with monitoring. The General Vet AI discusses when to pursue advanced imaging. Otitis media/interna can cause peripheral vestibular—check ears.
Use Neurology Specialist, Vital Signs Reference, and General Vet AI for vestibular assessment.
- Old dog vestibular syndrome is common—often idiopathic, peripheral.
- Peripheral: head tilt, horizontal nystagmus, ataxia—usually improves.
- Central: vertical nystagmus, limb weakness, mentation change—warrants workup.
- Supportive care—antiemetics, nursing, time.
- Rule out otitis—middle/inner ear infection can cause same signs.