Head Tilt in Rabbits

Head tilts in pet rabbits are a common condition. The condition may present as a mild case with only a mild head tilt without much other complication, but more commonly, head tilt rabbits are presented with circling and sometimes uncontrollable rolling.

The most common causes for head tilt in rabbits are either infection of Encephalitozoon cuniculi and Ottis media/ interna, however other causes like nervous system infection and neoplasia are also possible.

Encephalitozoon cuniculi is an obligate protozoa that is found in rabbits. The spores are shed in the urine in infected rabbits and are transmitted via ingestion or inhalation in feed or bedding. These spores can stay in the environment for up to 4 weeks, but can be easily killed by routine disinfectants. Most rabbits that are infected are actually asymptomatic. But when they become symptomatic, signs usually include head tilt, rolling, circling, nystagmus; rabbits may become inappetant or have gut stasis.

Serology is a way of making a presumptive diagnosis. Although a positive titre result making the E. cuniculi infection more likely in a ill rabbit, but does not confirm the diagnosis, however a negative result rules it out. So recent years, we use PCR for testing E. Cuniculi, which is a more sensitive and specific test.

Treatment for E.cuniculi is simple; most commonly, the vet may use fenbendazole for a duration of 28 days. More importantly, supportive care is crucial in these patients especially in the initial phase of the disease. A lot of these rabbits are unable to stand up straight and sometimes have difficulty taking hay and eating or drinking, therefore it is important for us to provide supportive care, which includes feeding regularly and keeping them hydrated in the means of giving subcutaneous fluid or on intravenous fluids, but also husbandry- which includes padding the cage with soft bedding to prevent them from traumatic injuries when they are rolling; sedation may be needed to keep them calm and less nauseas. The other major differential is otitis media/interna (middle or inner ear infection). Rabbits normally produce wax in the ear canals, which can be brownish or cream colour. Lop-eared rabbits are more prone to ear infections. In some rabbits that have severe otitis media, a deep ear lavage may be beneficial, however this should be done under sedation or anaesthesia.

To evaluate the middle and inner ear, often radiographs and even a CT-scan are required. These images not only evaluate the severity of the infections, but are also useful to assess the bulla and determine whether surgery is required.

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