Clinical reasoning in canine vestibular syndrome: Which presenting factors are important?

Abstract

Background: Although the use of clinical reasoning has been evaluated for several neurological presentations, this approach has not yet been investigated for dogs with vestibular syndrome. Methods: Two hundred and thirty‐nine dogs presenting with vestibular syndrome were included in this retrospective study. Univariate analysis of variables (clinical history, signalment, clinical presentation and neurological examination findings) was performed. Variables with p < 0.3 were selected for logistic regression. Results: Ninety‐five percent of dogs were represented by eight conditions: idiopathic vestibular disease (n = 78 dogs), otitis media interna (n = 54), meningoencephalitis of unknown origin (n = 35), brain neoplasia (n = 26), ischaemic infarct (n = 25), intracranial empyema (n = 4), metronidazole toxicity (n = 3) and neoplasia affecting the middle ear (n = 3). Idiopathic vestibular disease was associated with higher age, higher bodyweight, improving clinical signs, pathological nystagmus, facial nerve paresis, absence of Horner's syndrome and a peripheral localisation. Otitis media interna was associated with younger age, male gender, Horner's syndrome, a peripheral localisation and a history of otitis externa. Ischaemic infarct was associated with older age, peracute onset of signs, absence of strabismus and a central localisation. Conclusions: Discrete clinical features can be used to identify the most likely diagnosis in dogs with vestibular syndrome.

Vestibular syndrome in dogs: how to keep a level head

“…5,6 In a paper summarised on p 226 of this issue of Vet Record, Harrison and colleagues provide a detailed overview of 239 dogs with vestibular syndrome, all retrospectively reviewed and statistically analysed for cues relating to signalment, disease progression and specific clinical signs and their association with the underlying diagnosis. 7 This is encouraging reading for those of us who find ourselves taking a step back or rushing towards the telephone to call the nearest neurological referral centre when we are presented with a non-recumbent dog with a head tilt and nystagmus.…”

“…Meanwhile, the most likely diagnosis in older dogs with signs of peripheral vestibular disease is idiopathic vestibular disease. 7 In these cases, the clinician might just choose to await spontaneous regression of the clinical signs.…”

“…However, 95 per cent of the cases examined in their study were covered by just eight diagnoses: idiopathic vestibular disease, otitis media interna, meningoencephalitis of unknown origin, brain neoplasia, ischaemic infarct, intracranial empyema, metronidazole toxicity and neoplasia affecting the middle ear. 7 Concentrating on these eight key diagnoses already makes the clinical decision-making process easier. However, to narrow the list of differentials even further, and bearing in mind that these cases were all collected at a referral hospital, one may even choose to focus on just the five most common diagnoses.…”

“…This can be determined with reasonable confidence based on the neurological examination results, 8 Harrison and colleagues' study provides convincing evidence that the most likely diagnosis in young dogs with signs of peripheral vestibular disease is otitis media interna, especially in dogs with a previous history of otitis externa. 7 This likely diagnosis suggests a need for advanced diagnostic imaging and the planning of further treatment (medical and possibly surgical). Meanwhile, the most likely diagnosis in older dogs with signs of peripheral vestibular disease is idiopathic vestibular disease.…”

Key feature-cases as virtual patients in education of veterinary neurology

“…The first three basic cases deal with the neurological examination, a scheme for reflecting upon differential diagnoses (VITAMIN D scheme) (21) and the 5-finger rule for Clinical Reasoning (24). In several studies evaluating the 5-finger rule (onset, clinical course, symmetry of clinical signs, pain and neurological localization) and signalment for Clinical Reasoning specific patterns were identified to help in diagnosing and differentiating neurological diseases in dogs or cats (see Figure 1) (22,23,(25)(26)(27)(28). Furthermore 35 patient cases on the most frequently occurring diseases of the central and peripheral nervous system as well as myopathies could be created.…”