Cinema Veterinary Centre

Article in "Pet Me! Magazine," written by Cinema Veterinary Centre's own DVM Amber Wheelbarger!!

Posted on Aug 14, 2017 by deborah  | Tags: rabbits, hares, neurologic, head, tilt

For a rabbit, this sudden loss of control must be terrifying and confusing. Unfortunately, it is a very real condition and one of the more common medical conditions we see in pet rabbit practice.


Article in "Pet Me! Magazine," written by Cinema Veterinary Centre's own DVM Amber Wheelbarger!!

For a rabbit, this sudden loss of control must be terrifying and confusing. Unfortunately, it is a very real condition and one of the more common medical conditions we see in pet rabbit
practice.

Rabbits are becoming popular pets today. They work well indoors and can live in smaller environments often found in the suburbs and cities. They are small sized, can be litter trained and are full of fun antics. However, one of the more common health conditions we treat them for is sudden head tilt, also called wry neck or Labyrinthine Torticollis. This condition is a description of how they look rather than a diagnosis itself. Rabbits with this condition will suddenly have a dramatic cock of their head to one side that they cannot correct. Sometimes they have rapid eye movements from side to side. And sometimes they twist so much that they will try to spin around and around seemingly unable to stop. Head tilt can have many possible causes and should be seen by a veterinarian skilled in rabbit care as soon as possible. Sometimes an early diagnosis
and treatment can dramatically improve the outcome for your rabbit friend.

There are many possible causes of this type of neurologic disease. An inner ear infection or a brain infection with a parasite called Encephalitozoon Cuniculi are the most common causes. Other possible causes include a brain infection or even brain cancer. We may also consider trauma to the head or vertebral column. It is a less likely possible cause, but if there was some form of trauma like a fall from a table, than this would be strongly considered. Additionally, if the rabbit has outdoor exposure we consider overheating, heavy metal toxin exposure, or even larva migration through the brain of either Cuterebra fly larva or Roundworms as possible causes. These are rarer still, but depending on the rabbit’s life-style they may need to be
considered, especially if the causes listed above are eliminated by testing.

As a veterinarian every case is like a mystery. We work to find out which of the possible disease suspects is causing this odd behavior. We will want to start by finding out the rabbit’s life story - where it is housed and what other animals it has been exposed to. Next, we will do an exam and look for signs of an ear infection or other symptoms that may point us in one of the above diagnostic directions. However, sometimes there are no outwards signs to assist our diagnosis, so we have to recommend tests.

What are some of the tests we might recommend? To start, an X-ray will likely be recommended. It can look for changes to the skull or help detect spine trauma or disease. An X-ray of the skull also looks at the bony structures of the inner ear for signs of an inner ear infection, the number one cause of head tilt. In larger specialty hospitals, MRI or CT scans can also be used for this and can identify earlier or subtler changes than a standard X-ray. As part of a standard workup for a sick patient we usually also recommend general blood and urine testing. This looks at white and red blood cell counts and blood chemistries to assess organ disease and changes in electrolytes. This can help identify systemic diseases that may be involved as well and help us tell you what kind of prognosis to expect with better accuracy.

In addition, a few specific tests can be run to help us narrow down the list of possible suspects further. Encephaloitzoon cuniculi infection is a widespread, but often hidden, parasitic brain disease in pet rabbits. By some estimates it affects 50-75% of rabbit colonies but does not always cause noticeable disease. It is a single cell protozoan parasite. Rabbits are usually infected by their mothers, but can remain symptom free for years. Next to inner ear infections this is the next most common cause of head tilt. We can check for it with a blood test looking for elevated
antibody levels. If positive, we can attempt to eliminate it with medications, but success is variable because sometimes the parasite has already caused damage to the brain and sometimes the main symptoms are the result of the secondary inflammation that the parasites cause. Other tests that are often recommended are cultures of a suspicious ear infection or nasal infection that might have spread to the brain. This test will tell us not only what the possible cause of the head tilt is, but what antibiotics will work best to treat it. Other blood antibody tests may be run as well.

Finding a diagnosis is only part of the process in treating a pet rabbit for head tilt. Part of caring for a rabbit with this condition is medication aimed at the probable or diagnosed cause. The other
part is tender loving care. Wrapping these bunnies in towels to prevent them from spinning and hurting themselves further during recovery is often necessary. Also, if the rabbit is too wobbly to get to its food, it may be necessary to help them. This sometimes means hand-feeding them purred food by syringe and even offering water by syringe as well. Sometimes they may need medications to help improve their appetite or help treat seizures caused by their brain disease. It can take days to weeks of intensive care to help a bunny during this type of crisis. Sometimes this can be done at home if the rabbit’s owner has time to commit to it. Alternatively, sometimes these rabbits are hospitalized for nursing care. Unfortunately, not all rabbits with this condition respond to medication. Some rabbits with more severe symptoms do not improve despite very intensive care and euthanasia may be recommended to ease their suffering. It is a sad fact of this condition in our rabbit friends. However, we should not forget that the majority of these cases do at least show a halting in the progression of symptoms if we treat them soon enough and many will show a complete recovery with proper treatment.

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