Vestibular disease in cats

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Vestibular disease in cats often is due to a lesion that occurs after birth and may be associated with an underlying immune-mediated process.[6](#jvim14777-bib-0006){ref-type="ref"}, [7](#jvim14777-bib-0007){ref-type="ref"} Cats with central vestibular disease, by contrast, can present with signs of acute or chronic vestibular dysfunction in kittens and adults.[7](#jvim14777-bib-0007){ref-type="ref"}, [8](#jvim14777-bib-0008){ref-type="ref"} Although it has been suggested that the inner ear may undergo a period of rapid development during early postnatal life, in which the vestibular system is particularly susceptible to injury,[6](#jvim14777-bib-0006){ref-type="ref"}, [9](#jvim14777-bib-0009){ref-type="ref"} there is no evidence to support this hypothesis. Thus, the underlying mechanisms of central vestibular disease in young cats are currently unknown. Furthermore, little is known regarding the specific etiology or pathogenesis of this disorder.

The purpose of this study was to describe a series of 10 cases of acute to chronic central vestibular disease in domestic shorthair cats. Diagnostic criteria included acute or subacute onset of vestibular signs associated with symmetric, bilateral, and diffuse head tremor, circling behavior, and unresponsiveness to manual or auditory stimuli. An underlying cause, such as neoplasia or systemic disease, could not be identified in any of the cases.

Materials and Methods {#jvim14777-sec-0007}


This retrospective observational study was approved by the University of Pennsylvania's Institutional Animal Care and Use Committee (IACUC). It involved medical records review of all cases of cats with clinical signs of vestibular disease evaluated at the Penn Vet's Center for Veterinary Medicine over a 25‐year period from 1 January 1987 through 31 December 2012. Cases were identified using standard searches within the electronic medical record system and by reference to the medical literature and prior studies conducted at Penn Vet.

Disease duration, clinical features, and outcome (as reflected by the presence or absence of persistent signs) were recorded for each case. Any changes in clinical signs of vestibular disease following treatment were recorded.

Feline brainstem or cerebellar samples were available for histopathology and immunohistochemistry (IHC) in 3 cases. These were fixed in 10% neutral buffered formalin, processed in paraffin wax, sectioned in 4‐μm thick slices, and stained with hematoxylin and eosin or immunostained using a commercially available antibody for the glial fibrillary acidic protein (GFAP, Dako, Carpinteria, CA). To quantify changes in GFAP expression, the percentage of GFAP‐positive astrocytes in the cerebellar samples was calculated by a blinded observer using Image J analysis software (<,>,) at 200× magnification. A similar histopathologic procedure was performed on one case of immune‐mediated vestibular disease (IDV), a disease in which the vestibular component of the lesion was believed to represent immune‐mediated tissue injury.[25](#jvim14777-bib-0025){ref-type="ref"}, [26](#jvim14777-bib-0026){ref-type="ref"} Brainstem tissues from a neurologically normal cat were used as a positive control.

Statistical Analysis {#jvim14777-sec-0008}


Data were analyzed using commercially available software (GraphPad Prism Version 5, GraphPad Software Inc, San Diego, CA). The Fisher's exact test was used to evaluate associations between categorical variables, and Kruskal--Wallis test was used for continuous variables. Variables identified as significantly different (*P* <, .05) in the univariate analysis were included in a multivariate logistic regression analysis. Variables with *P* <, .05 were considered statistically significant.

Results {#jvim14777-sec-0009}


A total of 25 cats (20 domestic shorthair, 5 long‐haired) met the inclusion criteria for the study and were included in the analysis. One cat was excluded from the study because it had a systemic illness at the time of presentation. Ten cats were diagnosed with vestibular disease, 10 with a non‐neurologic primary disease, and 5 with immune‐mediated vestibular disease.

Clinical characteristics of the cats included in the study are listed in Table [1](#jvim14777-tbl-0001){ref-type="table-wrap"}. Cats were aged between 0.5 and 11 years (median 6.7 years), were all female, and included 2 intact and 23 neutered cats. The most common cause of vestibular disease was idiopathic (26%) and non‐neurologic (30%) in origin, followed by immune‐mediated vestibular disease (22%). Most of the cats had been presented with ataxia (64%), followed by head shaking (48%), head tilt (32%), circling (28%), and head rubbing (24%). A history of systemic disease or treatment was present in 68% of the cats.


Summary of clinical information in cats included in the study.

Clinical Information

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