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Making the decision to humanely euthanize a pet can be a traumatic one, especially if you think your pet is acutely deteriorating.
One classic scenario that I often see in the emergency room is people bringing in their pet to euthanize for having an acute stroke. However, before you consider euthanizing, pay heed! I’ve often had to convince owners not to euthanize when they suspect that their dog or cat has acutely “stroked out.”
In today’s blog, we’ll cover dogs and “acute strokes,” while in next week’s blog, we’ll cover cats and their “acute strokes.”
It’s scary to see your dog suddenly look drunk, not be able to walk, develop rapid, abnormal eye movement (called a nystagmus) and fall to his or her side. When this happens, one common benign cause may be due to “old dog vestibular disease.”
What does this mean?
While it’s not the fanciest disease name, old dog vestibular disease looks like a stroke. In actuality, it’s an acute inflammation of the vestibular nerve. This nerve runs through the inner/middle ear and stems from the brain, and its purpose is to help us all to stay physically balanced. This is the same nerve that makes you motion sick or causes tinnitus.
Old dog vestibular disease occurs acutely for several reasons: from ear infections and sticking a Q-tip too far down in your dog’s ear to cleaning your dog’s ear with liquid ear medications, old trauma or underlying metabolic problems (like thyroid conditions), or for the simple reason that your dog is old.
Signs of old dog vestibular disease include:
The good news with old dog vestibular disease?
It typically resolves after a few days with marked, sudden improvement. In fact, it often goes away as soon as it is developed. Unfortunately, it can leave some rare side effects like a permanent head tilt (though that can make your dog even cuter by making him look eternally curious and perplexed!).
Unfortunately, if these signs don’t go away within a few days, the more serious differentials may include a brain tumor or severe inflammation of the brain. An MRI, CT, spinal tap, and a visit to the veterinary neurologist are a must.
Another rare cause for acute “strokes” in dogs is something called a fibrocartilagenous emboli (FCE). In dogs, FCEs occur when microscopic pieces of fibrous tissue and cartilage develop in the body and break off somewhere, blocking blood flow to the spinal cord. This results in acute, profound neurologic signs similar to old dog vestibular disease. FCEs can be seen more commonly in certain breeds such as Labrador retrievers, Miniature Schnauzers, and Shetland sheepdogs. The only true way to diagnose an FCE is by physical exam findings in conjunction with a CT or MTI (which needs to be done under anesthesia). Unfortunately, there is no cure for a FCE. However, with supportive nursing care, many dogs improve and recover from the paralysis; however, recovery may be gradual and slow as compared to old dog vestibular disease.
When in doubt, seek veterinary attention immediately – and if your veterinarian isn’t sure, a visit with an internal medicine specialist or neurologist is a must. Just keep in mind that not all “acute strokes” warrant a bad prognosis or euthanasia, and some may turn out okay with supportive care.
If you have any questions or concerns, you should always visit or call your veterinarian – they are your best resource to ensure the health and well-being of your pets.
Like their owners, dogs can be affected by a number of emergency health conditions, including strokes. While strokes are less common in dogs than they are in humans, they are equally as serious. Witnessing your beloved dog having a stroke is a frightening experience — and it’s important to know what to do if this occurs.
According to the National Stroke Association, a stroke occurs when there is a disruption of blood flow to the brain, depriving brain cells of their oxygen supply. This often happens suddenly and without warning. The extent of the damage and its impact on the dog varies depending on the part of the brain affected.
In both humans and dogs, strokes are typically classified as either ischemic or hemorrhagic. “An ischemic stroke occurs when a vessel that supplies blood to a part of the brain becomes blocked, and damage to the brain tissue occurs,” says Dr. Jennifer Coates, a veterinarian who serves on the advisory board for Pet Life Today. “In a hemorrhagic stroke, a vessel in the brain bleeds, which leads to swelling and increased pressure,” she adds. Both types of stroke deprive the brain of blood and oxygen, which causes brain cells to die. Ischemic strokes are more common than hemorrhagic strokes in both people and dogs.
The severity of the stroke depends on how long the brain goes without blood flow. Dr. John McCue, a staff neurologist at the Animal Medical Center in New York City, says that when a dog has a massive, catastrophic stroke in a certain part of the brain, he may not bounce back because essential parts of the brain have been damaged. This can result in a lower quality of life and can sometimes be fatal. But the good news is that a stroke is not always life-altering. Long-term prognosis is good in dogs who are treated early and given the supportive care they need.
Dogs can also experience a Fibrocartilagenous Embolism (FCE), more commonly known as a “spinal stroke.” This occurs when a piece of an intervertebral disc — the cushion that separates each of the dog’s vertebrae — breaks off and causes an obstruction of one of the blood vessels in the spinal cord.
Dr. Gary Richter, owner and medical director of Montclair Veterinary Hospital in Oakland, California, explains that spinal strokes often cause partial or complete paralysis of one or more limbs, depending on where in the spinal cord they occur. He also points out that not all strokes are definitively diagnosed. “It usually takes an MRI to reach a definitive diagnosis — something that isn’t affordable for all pet owners,” he says. “There are probably a lot of ‘mini’ strokes that don’t get diagnosed.”
The signs of a stroke can be subtle and hard to notice. There are no warning signs to indicate that a stroke is about to happen, and Dr. Coates explains that a dog can go from “seemingly normal” to “severely impaired” very quickly. If left untreated, the problem can worsen in a short period of time. The longer treatment is put off, the greater the chance for permanent neurological damage.
Common signs that your dog might be having a stroke include:
However, it is important to note that other conditions can cause similar signs. Idiopathic Vestibular Syndrome, in particular, is a common condition of older dogs that can mimic the signs of a stroke. The vestibular system is a delicate array of structures located in the inner ear and brain, which helps dogs maintain balance and coordinate the position of their head, eyes, and legs.
According to Dr. Jerry Klein, Chief Veterinary Officer of the American Kennel Club, any disruption to the vestibular system can cause symptoms such as head tilt, loss of balance, falling or rolling to one side, circling, trouble walking, and abnormal eye movements. Because disruptions to the inner ear can make dogs extremely dizzy, pet owners may also notice signs such as nausea, vomiting, and loss of appetite. Although these signs can be frightening, the good news is that most dogs recover from vestibular disease. Dr. Klein notes that while some may continue to have a head tilt, most dogs regain their sense of balance and do just fine.
According to Dr. McCue, ischemic and hemorrhagic strokes occur most commonly in older dogs. Spinal strokes are more common in larger, more active breeds.
Strokes also tend to occur more often in dogs that have concurrent health problems. According to the American Animal Hospital Association (AAHA), dogs are at greater risk for having a stroke if they are also affected by other illnesses such as heart disease, diabetes, kidney disease, Cushing’s disease, and Rocky Mountain Spotted Fever, among others. While your dog’s previous medical history may provide some clues, about 50 percent of canine strokes have no specific underlying cause.
Unfortunately, there is no way to prevent a stroke from happening in your dog, but keeping your pet healthy can make a stroke less likely. Regular veterinary checkups are especially important because early detection and treatment of underlying diseases can reduce your dog’s risk of having a stroke.
If you suspect your dog has had a stroke, seek veterinary care immediately. If your dog has dark red mucous membranes — in places such as his gums or inner eyelids — this can indicate a lack of oxygenation, according to AAHA. If this occurs, quick treatment is essential to restore proper blood flow. Dr. Richter also advises keeping your dog calm and preventing any injuries that could occur from falling or hitting his head.
Proper diagnosis of a stroke is crucial in order to ensure your dog receives appropriate treatment. Your veterinarian will perform a full physical examination and may recommend additional testing such as blood work, urinalysis, or X-rays to rule out other underlying problems. Because strokes are often related to heart disease, your veterinarian may recommend a full cardiac workup, which can include tests such as an electrocardiogram, chest X-rays, or cardiac ultrasound. In order to definitively diagnose a stroke, an MRI or CAT scan may be recommended to rule out other brain diseases that can cause similar clinical signs.
Your dog’s ability to recover from a stroke depends on several factors, including the type of stroke, the severity, any underlying medical conditions, and how quickly your dog received appropriate treatment. Some dogs will begin to show signs of improvement in just a few weeks, while others may need more time. Unfortunately, some dogs will never fully recover from a stroke and, in some cases, the stroke or its associated complications can be fatal. But “with appropriate veterinary care and a dedicated owner,” Dr. Coates says, “many dogs can go on to live happily for quite a long period of time after having a stroke.”
Last Updated: March 29, 2019
This article was co-authored by Pippa Elliott, MRCVS. Dr. Elliott, BVMS, MRCVS is a veterinarian with over 30 years of experience in veterinary surgery and companion animal practice. She graduated from the University of Glasgow in 1987 with a degree in veterinary medicine and surgery. She has worked at the same animal clinic in her hometown for over 20 years.
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Witnessing your dog suffering with any type of illness or discomfort can be very unsettling for an owner. The signs of a canine stroke can be extremely frightening, although it is important to remember that this condition does not generally affect dogs as severely as it does humans. Learn to recognize the warning signs of canine stroke so that you can respond appropriately if this happens to your dog. If you think your dog has had a stroke, seek help from a vet right away and follow all treatment instructions carefully.
In the last year of Mackenzie's life he suffered from what our veterinarian had diagnosed to be Vestibular Syndrome, also known as Old Dog Syndrome. I remember the feeling of relief that came over me when I heard this since it is common in senior dogs and most recover
Vestibular Syndrome is the sudden loss of balance accompanied by disorientation, rapid eye movements and a head tilt, making walking difficult, if not impossible. Most dogs fully recover in 2-3 weeks, with some dogs showing residual symptoms, such as a head tilt, for life. The most severe clinical signs tend to occur within the first 24 - 48 hours.
Stroke or cerebrovascular accident (CVA) is the most common clinical manifestation of cerebrovascular disease, and can be broadly divided into ischemic stroke (sudden lack of blood supply to the brain) and hemorrhagic stroke (burst blood vessel). Signs of a stroke can also include loss of balance, head tilt and difficulty in walking. Performing an MRI is often used to diagnose a stroke and to differentiate the clinical signs from other brain diseases that require more specific treatments.
Just as with human beings, our senior dogs tend to be more at risk due to the higher prevalence of underlying conditions that may lead to a vascular event (ischemic stroke or hemorrhagic stroke) .
While the symptoms of Vestibular Syndrome are always the same, the underlying cause may be different. Underlying causes can include a stroke, infectious diseases, inflammatory diseases etc. If the stroke affects the brainstem or the cerebellum it may cause Vestibular Syndrome. However, strokes may also affect the forebrain, in this event the clinical signs are not associated with Vestibular Syndrome.
While there is little that can be done to prevent a stroke or vestibular disease, the underlying cause may be treatable thus reducing the overall risk of a vascular event.
Once a stroke or vestibular disease is diagnosed, most treatment protocols include supportive care and time. Medication to help with the dizziness may be prescribed and it is very important that your dog has supervision at all times to ensure they do not hurt themselves during this time of disorientation. There are many dogs that do recover to live long, full lives it really depends on the underlying condition, age and overall health of your dog.
I still remember how I had to carry Mackenzie everywhere because he could barely stand. I often kept him in his Dogger stroller when indoors so he had a great view of everyone and everything, while staying out of harms way. I tried using a walking sling, but he was so unbalanced that even a sling did not help so I stuck with using my hands. I'd hold him to eat, to drink, to take care of his 'business' outside and I would have done it for a lifetime if needed.
My only wish was that I better understood what happened to him and the more I read on the subject, the more I see the need for greater research. We have come such a long way with humans, but have only started to scratch the surface when it comes to strokes in dogs - at least we now acknowledge that strokes in dogs do in fact happen and isn't admitting we have a problem the first step in recovery?
*MRI Images courtesy of Dr. Filippo Adamo, DVM, Dipl. ECVN, East Bay Veterinary Specialists, Walnut, CA
Ann-Marie Fleming is the Founder & CEO of Dog Quality, a provider of products focused on improving the quality of life for older dogs.
Evelyn Galban, DVM, MS, DACVIM, associate professor of Clinical Neurology at the University of Pennsylvania School of Veterinary Medicine, says that when a dog has a suspected neurologic problem, a veterinarian will begin their assessment with a thorough history, including questions like:
Has there been travel or injuries?
Did they eat something they should not have, or are they receiving any medications?
You can expect your dog to receive a physical examination and a more specific neurologic examination, testing nerve function and reflexes.
“Often, tests to evaluate systemic health, like blood work or urinalysis to look at blood cells and organ function, will be recommended,” Galban says. “Often imaging the area will be a next step, and that includes radiographs or more advanced diagnostics, like MRI or CT scan.”