Stroke symptoms?

[Chatter]

I heard a bit of commotion last night, but figured he was rearranging his living quarters, as is usuual after I clean his cage. About an hour later, I found him upright but twisted toward his right side. At first I though he was just cleaning his foot but when I moved him toward his veggies, he immediately contorted right again and started turning in tight circles to the right. I picked him up. His head was a bit wobbly, like a bobble head. He is very disoriented, unable to eat or drink, and will circle toward the right until he reaches a corner, and that seems to interrupt the pattern.

Vet checked his ears with long q-tips. They were very clean, so he ruled out ear infection. Right eye has severe nystagmus. Vet concluded it was likely a stroke. We are doing three days of steroids and injected antibiotics. I am hand-feeding him and feeding water through a syringe. He is continuing to turn right.

I can't find much about strokes in rabbits. The usual conclusion seems to almost always be head tilt or EC. My bunny's head and body are turned toward the right, but his head is not tilted.

I am inclined to agree with the stroke diagnosis but I would appreciate any input or hearing from anyone else whose rabbit exhibited similar symptoms. My rabbit is 11 1/2 years old, mini-lop.

 

[JBun]

Ear infection is still a possible cause and can't be completely ruled out just by a visual exam of the ear canal, because it can be an inner ear infection that hasn't ruptured into the external canal, therefore would not be visible. It will usually take xrays to determine this, even then it may not show up. In which case vets will treat the rabbit based on symptoms presented. The vet also needs to conduct a dental exam with xrays, to rule out a dental infection related to the ear infection, as it is common for the two to be linked. Though because your rabbit is older and xrays often would require a GA to accomplish, which would be risky in an older rabbit, you may not want to risk xrays and instead opt for a visual exam and treating based on the findings and on symptoms presented. Ear infections are also especially prevalent in lop eared rabbits.
http://www.medirabbit.com/EN/Neurology/Otit/otitis.htm

E. cuniculi is also another likely cause. It doesn't always present in a tilted head. Circling and nystagmus are also symptoms of it. A blood titer can be done to check for antibodies to it, but does not necessarily indicate an active infection, so most vets will treat with panacur and metacam, based on symptoms.
http://www.gwexotics.com/wccms-resources/a/5/0/e/77554b90-a660-11e0-a685-0050568626ea.pdf

Most vets will treat for both EC and an ear infection when a rabbit is presenting these symptoms and it can't be verified which is the exact cause, as these are the two most common causes of these symptoms. Medications commonly given would be Panacur(for EC), Antibiotic(ear infection, usually starting with baytril) and Metacam to bring down the inflammatory response and help minimize cell damage from occurring. Baytril is just the most common antibiotic vets will prescribe and not always the best, so another antibiotic may be needed. Treatment should be for at least 30 days, though longer may be needed, especially with the antibiotic. It is important to not stop the antibiotics too early. Metacam is the most common anti inflammatory prescribed. In very severe cases a vet may initially treat with a steroid, but careful consideration needs to go into this decision as it suppresses the immune system and can cause the condition to worsen. Metacam and a steroid cannot be given at the same time, and if giving metacam following a steroid, there is a certain number of days you need to wait before it is safe to do so.

Although stroke is a possibility, it is not as likely as an ear infection and EC, especially if your rabbit is not presenting with any weakness on the one side associated with the circling. A stroke isn't really treatable, EC and ear infection are and I would want to be treating for them in case they are the cause of symptoms, even if a stroke is the suspected cause.
Though this covers head tilt, circling would also be included as it is also a symptom associated with head tilt.
http://wildpro.twycrosszoo.org/S/00dis/Miscellaneous/HeadTiltVestibularRabbit.htm

Other less common causes for circling, are tumor, toxoplasmossis(especially if your rabbit has had contact with cat feces), and nematodiasis(roundworm from racoon, skunk, weasel)

Personally, unless your vet saw something else evident to indicate a stroke that hasn't been mentioned in your post, I would be looking for a different rabbit vet. EC and ear infection are the leading causes of these symptoms in rabbits, and a good rabbit vet would treat for them even when a stroke was suspected. This is only my opinion though, based on your description and what I know about these symptoms and how good rabbit vets commonly treat them.
http://rabbit.org/vet-listings/

Supportive care will also be important for your rabbit, including syringe feedings. But hopefully your vet covered this.
http://mohrs.org/index.php?id=palliative-care

 

[Chatter]

Thank you, I will use the link you provided to look for another vet and get a second opinion.

What are the causes of EC and ear infection? My rabbit is an indoor rabbit so his environment is quite stable. I don't have any other rabbits.

 

[Chatter]

The symptoms were spontaneous. He was fine one hour, and by the next hour he had the severe symptoms that I described. Would the spontaneity of the symptoms be most symptomatic of a stroke? He had not been shaking his head, worrying his ears, etc. priot to this. I saw absolutely no symptoms of ear irritation or anything being wrong up to one hour prior to the commotion I described.

Thank you so much for your feedback, I have located another vet and am continuing research though the links you provided. Most important to me his my little guy's quality of life. He's been such a wonderful companion for more than 11 years, and I don't want him to suffer.

 

[JBun]

Inner ear infections can sometimes be linked with dental disease or respiratory disease, and the infection spreads to the ear. E. cuniculi is a microsporidian parasite that is commonly carried by rabbits, passed on from their mother or picked up from food contaminated by other animals, but most never develop disease. For those that do, it is often because of a stressor occurring causing the disease to fully emerge. If you read the links I provided on both, they describe both diseases well.

Stroke symptoms do occur suddenly, but it can also be the case with EC and an ear infection. If the infection ruptures into the inner ear, this could cause sudden onset of symptoms. The progression of EC just depends on how quickly the spores erupt and affect the cells. It can be gradual or quick. Death can even occur within hours of the onset of symptoms. There is not really a set way that it progresses.

It may all be due to a stroke, but if it were my rabbit I would still want them on treatment for EC with panacur, an antibiotic cover in case of ear infection, and metacam for inflammation and pain relief. If you aren't sure about going to see a different vet, you could discuss with your current vet about getting your bun on panacur in case it is EC, continuing with several weeks of antibiotics for ear infection, and starting metacam once the steroids are stopped. Personally though, I would want a rabbit savvy vet treating my rabbit, as correct diagnosis and treatment can make all the difference in a rabbits recovery. I wouldn't have much confidence in a vet that didn't suspect EC or inner ear infection with symptoms of circling and nystagmus, unless there was something very specific that pointed to stroke and not the other two. Maybe you could ask the vet why (s)he thought stroke and not EC or inner ear infection.

When doing your research, you want to try and stick with more reputable sites, preferably ones that are medically based, as there is a ton of inaccurate info out there. Medirabbit and wildpro are two of the best for accurate disease and treatment info for rabbits.