Q: I have just come home to discover my 5-year-old female ferret with a severe right head tilt. Last night she was her active normal self. She also has hind end weakness and yellowish discharge from her eyes. Her appetite is good, water intake is good, and she is peeing and pooping well. She is treated with a flea and heartworm preventive every four to six weeks, her ears are clean, and no noticeable color difference. Any suggestions for what’s wrong with her?
A: Deciding what causes a head tilt can be very difficult. Unless there is obvious discharge coming from the ear, usually there are no simple clues. Head tilt is usually caused by damage to one or more nerves or nerve center in the body.
Doctors usually put the cause of head tilt into two categories to help track down the problem. Either there are central nerves (in the brain) that cause a head tilt or peripheral nerves (nerves coming from the brain) that cause a head tilt. It is important to try to tell the difference because diagnostic tests, treatment and prognosis all depend on which nerves are diseased.
What tests do doctors use to tell the difference? It starts with a physical examination along with a more specific neurologic examination. If the eyes move a certain way, this can indicate either central or peripheral nerve damage. If the entire body is affected, not just the head, then central damage is more likely. If there is discharge from the ear, then peripheral damage is probably present. Your doctor will also use an otoscope to look in the ear to see if the eardrum is intact and if any fluid is present. Severe mite infection in the ear can cause a head tilt, but this is usually easy to find and diagnose.
Typically, blood work does not allow your doctor to distinguish the different types of neurologic disease. Radiographs are also usually not very helpful. Advanced imaging techniques such as a CAT scan or MRI might help your doctor tell which type of disease is present. But with the ferret’s relatively small size, it might not be possible to use these tests for a diagnosis.
Another step many doctors will use if the cause is not apparent is to treat for a peripheral nerve infection and inflammation. This usually means a combination of an antibiotic and an anti-inflammatory medication. If the ferret gets better, the guess was correct. If the ferret does not get better, then the cause of disease is more likely to be a central nerve problem.
Ultimately, the main cause of most head tilts are infectious, usually mites along with a secondary bacterial infection. This is a peripheral nerve problem. Other causes can be cancer, abscess, toxin or trauma.