Welcome to the latest edition of the BVNS Neurotransmitter.
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.
Based on this videotape where would you localize the lesion and why?
Central vestibular because he is non-ambulatory, extreme head tilt to the right, leaning right but no nystagmus.
Peripheral vestibular cases are fairly 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 than 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 an 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 firstname.lastname@example.org.