Introduction:

Duke is a 7 year old, MC, Pitbull presenting for right head tilt that was a gradual onset and progressive over the last 6 weeks. Hypermetria on the left thoracic limb was noted about 6 months ago. He is bright and responsive at home and does not seem painful.

Video:

Based on this videotape where would you localize the lesion and why?

Duke from Bush Veterinary Neurology on Vimeo.

Answer:

Central vestibular because he is non-ambulatory, extreme head tilt to the right, leaning right but no nystagmus.

Discussion:

Peripheral vestibular cases are familiar to us all. They have a sudden onset of a head tilt, veer and side-step to the side of the head tilt and have rapid (greater that 60 beats per minute) rotary and/or horizontal nystagmus whose fast phase is opposite the head tilt. Whenever a presentation deviates from this presentation then likely to be within the brainstem. In Duke's case he is non-ambulatory, has extreme head tilt but no nystagmus - definitely not what you would expect for a peripheral lesion.

Duke's MRI shows a brain tumor.

Thank you to Dr. Skinner of Hartfield Animal Hospital for referring Duke to BVNS.

If you have any questions about this case, please contact Bill Bush at [email protected].