Idiopathic or otitis are your top ddx

Vet Record 2025

Jordina Caldero Carrete, Steven De Decker, Holger A. Volk, Rodrigo Gutierrez-Quintana, Anna Morgana Mosel, Rita Gonçalves

Background:
Peripheral vestibular syndrome (PVS) in cats is a clinical condition characterized by head tilt, ataxia, and nystagmus. Despite its frequency in feline neurology, literature on the diagnostic distribution and outcomes of PVS is limited. This study aimed to assess the clinical features, underlying causes, diagnostic findings, and short-term outcomes in a large population of cats with PVS to improve diagnostic and prognostic approaches.

Methods:
This retrospective multicenter study included 174 cats diagnosed with PVS between 2010 and 2020 across six referral veterinary hospitals. Data collected included signalment, clinical signs, diagnostic tests (e.g., otoscopic exam, MRI, CSF analysis), final diagnoses, and outcomes. Cases were classified into specific etiological categories, including idiopathic, otitis media/interna, neoplastic, traumatic, and others. Statistical analyses assessed associations between clinical features, diagnostic results, and outcomes.

Results:
The most common diagnosis was idiopathic vestibular syndrome (40%), followed by otitis media/interna (29%) and neoplasia (10%). MRI was the most effective imaging modality, especially in identifying neoplastic and central causes. Otoscopic findings were normal in most cases. Clinical signs included head tilt (96%), ataxia (89%), and nystagmus (66%), with bilateral signs in 13% of cases. Most cats had favorable short-term outcomes, with resolution or improvement in 89% of idiopathic cases and 77% of otitis cases. Cats with neoplasia had significantly worse outcomes. Steroids or antibiotics were commonly used in infectious or inflammatory etiologies.

Limitations:
Retrospective data collection and variability in diagnostic workup and follow-up limited consistency. Not all cases underwent advanced imaging or CSF analysis, potentially underrepresenting central or infectious causes. Long-term outcomes were not assessed.

Conclusions:
Idiopathic and otitis-related PVS are the most common etiologies in cats, generally associated with favorable short-term outcomes. MRI is a valuable tool for differentiating between causes, particularly for detecting neoplasia. Comprehensive diagnostics and prompt intervention can lead to improved clinical management and outcomes in feline PVS.

Transverse (a) T2-weighted (T2W), (b) T2W fluid-attenuated inversion recovery (FLAIR), (c) T1-weighted (T1W) pre-gadolinium contrast and (d) T1W post-gadolinium contrast administration magnetic resonance images at the level of the tympanic bullae in a cat with an aural polyp and otitis media/interna. There is T2W/FLAIR hypo to isointense and T1W hypointense material filling part of the ventromedial compartment of the left tympanic bullae, surrounded by T2W/FLAIR hyperintense and T1W isointense material. The left cochlea has a mild loss of T2W signal and does not suppress on FLAIR. Postcontrast images show moderate heterogeneous enhancement of the material, bulla lining and cochlea. The left facial and vestibulocochlear nerves are mildly thickened (c, arrow) and contrast enhancing. There is mild and focal meningeal enhancement (d, dotted arrow)

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